Improved survival with adjuvant chemotherapy in locally advanced rectal cancer patients treated with preoperative chemoradiation regardless of pathologic response

Gahagan, John V.; Whealon, Matthew D.; Phelan, Michael; Mills, Steven; Jafari, Mehraneh D.; Carmichael, Joseph C.; Stamos, Michael J.; Zell, Jason A.; Pigazzi, Alessio

doi:10.1016/j.suronc.2019.10.021

Cited by 18 publications

(17 citation statements)

References 27 publications

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“…Despite the heterogeneity of the inclusion criteria, several retrospective studies have also reported that there is no significant oncological benefit of ACTx in low-risk patients with good response to PCRT[ 17 , 18 , 26 - 31 ]. Even in the long-term analysis of the 10-year cumulative cancer-specific survival, ACTx had no significant impact on patients with ypTis-2N0M0 stage in our previous report[ 32 ]. The possible risk factors associated with oncological outcomes are tumor regression grade[ 33 ], yp stage[ 27 ], cT stage and resection margin status[ 28 ], tumor grade[ 18 ], and residual tumor of ypT1–4[ 31 ].…”

Section: Discussionmentioning

confidence: 78%

Evaluating the benefit of adjuvant chemotherapy in patients with ypT0–1 rectal cancer treated with preoperative chemoradiotherapy

Jeon

Park

Kim

et al. 2021

WJGS

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BACKGROUND Adjuvant chemotherapy (ACTx) is recommended in rectal cancer patients after preoperative chemoradiotherapy (PCRT), but its efficacy in patients in the early post-surgical stage who have a favorable prognosis is controversial. AIM To evaluate the long-term survival benefit of ACTx in patients with ypT0–1 rectal cancer after PCRT and surgical resection. METHODS We identified rectal cancer patients who underwent PCRT followed by surgical resection at the Asan Medical Center from 2005 to 2014. Patients with ypT0–1 disease and those who received ACTx were included. The 5-year overall survival (OS) and 5-year recurrence-free survival (RFS) were analyzed according to the status of the ACTx. RESULTS Of 520 included patients, 413 received ACTx (ACTx group) and 107 did not (no ACTx group). No significant difference was observed in 5-year RFS (ACTx group, 87.9% vs no ACTx group, 91.4%, P = 0.457) and 5-year OS (ACTx group, 90.5% vs no ACTx group, 86.2%, P = 0.304) between the groups. cT stage was associated with RFS and OS in multivariate analysis [hazard ratio (HR): 2.57, 95% confidence interval (CI): 1.07–6.16, P = 0.04 and HR: 2.27, 95%CI: 1.09–4.74, P = 0.03, respectively]. Furthermore, ypN stage was associated with RFS and OS (HR: 4.74, 95%CI: 2.39–9.42, P < 0.00 and HR: 4.33, 95%CI: 2.20–8.53, P < 0.00, respectively), but only in the radical resection group. CONCLUSION Oncological outcomes of patients with ypT0–1 rectal cancer who received ACTx after PCRT showed no improvement, regardless of the radicality of resection. Further trials are needed to evaluate the efficacy of ACTx in these group of patients.

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Section: Discussionmentioning

confidence: 78%

Evaluating the benefit of adjuvant chemotherapy in patients with ypT0–1 rectal cancer treated with preoperative chemoradiotherapy

Jeon

Park

Kim

et al. 2021

WJGS

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“…NCCN guidelines recommend AC for patients with locally advanced rectal adenocarcinoma treated with upfront CRT. 4 Whether AC improves oncologic outcomes in this setting has been addressed previously using NCDB, and increased OS has consistently been observed [11][12][13] This likely minimized chances of under-staging and further limited the potential detrimental effect of inadequate surgery on OS. Second, independent subgroup analyses were conducted and strati ed by pathologic response according to both tumor and nodal status to allow for comparison of additional matched subsets.…”

Section: Clinicopathologic Characteristicsmentioning

confidence: 99%

Adjuvant chemotherapy after neoadjuvant chemoradiation and proctectomy improves survival irrespective of pathologic response in rectal adenocarcinoma: a population-based cohort study

Naffouje

Liu

Kamarajah

et al. 2022

Int J Colorectal Dis

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BackgroundThis study sought to determine whether adjuvant chemotherapy (AC) compared to no AC (noAC) after neoadjuvant chemoradiation (CRT) and resection for rectal adenocarcinoma prolongs survival. Current guidelines from expert groups are con icting, and data to support administering AC to patients who received neoadjuvant CRT are lacking. Methods 19867 patients met inclusion/exclusion criteria. Mean age was 58.6±12.0 years, and 12396 (62.4%) were males. Complete response (CR) was documented in 3801 (19.1%) patients and 8167 (41.1%) received AC.The cohort was strati ed into pathological complete (pCR, N=3,801) and incomplete (pIR, N=16,066) subgroups, and pIR further subcategorized into ypN0 (N=10,191) and ypN+ (N=5,875) subgroups. After propensity score matching, AC was associated with improved OS in the pCR subgroups (mean 139.1±1.9 vs. 134.0±2.2 months; p<0.001), in pIR ypN0 subgroup (141.6±1.5 vs. 129.9±1.2 months, p<0.001) and in pIR ypN+ subgroup (155.9±5.4 vs. 126.5±7.6 months; p<0.001). ResultsAC was associated with improved OS in patients who received neoadjuvant CRT followed by proctectomy for clinical stages II and III rectal adenocarcinoma. This effect persisted irrespective of pathological response status. ConclusionsAC following neoadjuvant CRT and surgery is associated with improved OS in patients with rectal adenocarcinoma. These ndings warrant adoption of AC after neoadjuvant CRT and surgery for clinical stage II and III rectal adenocarcinoma.

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“…In population studies, better outcomes, particularly OS, have often been reported in adjuvant-treated patients [105,106]. However, the selection of fitter patients for treatment prevents proper conclusions, even after appropriate matching [107].…”

Section: Information From Population Studies-need For Randomized Studmentioning

confidence: 99%

Adjuvant Chemotherapy in Elderly Colorectal Cancer Patients

Glimelius

Osterman

2020

Cancers

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The value of adjuvant chemotherapy in elderly patients has been the subject of many overviews, with opinions varying from “not effective”, since randomized trials have not been performed, to “as effective as in young individuals”, based upon many retrospective analyses of randomized trials that have included patients of all ages. In the absence of randomized trials performed specifically with elderly patients, retrospective analyses demonstrate that the influence on the time to tumour recurrence (TTR) may be the same as in young individuals, but that endpoints that include death for any reason, such as recurrence-free survival (RFS), disease-free survival (DFS), and overall survival (OS), are poorer in the elderly. This is particularly true if oxaliplatin has been part of the treatment. The need for adjuvant chemotherapy after colorectal cancer surgery in elderly patients is basically the same as that in younger patients. The reduction in recurrence risks may be similar, provided the chosen treatment is tolerated but survival gains are less. Adding oxaliplatin to a fluoropyrimidine is probably not beneficial in individuals above a biological age of approximately 70 years. If an oxaliplatin combination is administered to elderly patients, three months of therapy is in all probability the most realistic goal.

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Improved survival with adjuvant chemotherapy in locally advanced rectal cancer patients treated with preoperative chemoradiation regardless of pathologic response

Cited by 18 publications

References 27 publications

Evaluating the benefit of adjuvant chemotherapy in patients with ypT0–1 rectal cancer treated with preoperative chemoradiotherapy

Evaluating the benefit of adjuvant chemotherapy in patients with ypT0–1 rectal cancer treated with preoperative chemoradiotherapy

Adjuvant chemotherapy after neoadjuvant chemoradiation and proctectomy improves survival irrespective of pathologic response in rectal adenocarcinoma: a population-based cohort study

Adjuvant Chemotherapy in Elderly Colorectal Cancer Patients

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