Induction chemotherapy, chemoradiotherapy and consolidation chemotherapy in preoperative treatment of rectal cancer - long-term results of phase II OIGIT-01 Trial

Golo, D.; But‐Hadžić, Jasna; Anderluh, Franc; Brecelj, Erik; Edhemović, Ibrahim; Jeromen, Ana; Omejc, Mirko; Oblak, Irena; Secerov-Ermenc, A.; Velenik, Vaneja

doi:10.2478/raon-2018-0028

Cited by 23 publications

(18 citation statements)

References 26 publications

Supporting

Mentioning

Contrasting

Unclassified

Order By: Relevance

“…The goal of the present analysis was to evaluate this approach for patients with LARC-HR in Slovenia. Compared to our previous study with intensified neoadjuvant capecitabine based treatment with one induction cycle of capecitabine before CRT and two consolidation cycles before the operation, TNT achieved better pCR (17.5% vs 23.3%), T (55.5% vs 65%) , N (77.7% vs 96.7%) and stage (79.3% vs 83.4%) downstaging with comparable toxicity and compliance of patients 15. Direct comparison with the results of these near TNT study and other TNT studies is limited because in majority of them patients with stage II and III LARC were included.…”

Section: Discussioncontrasting

confidence: 56%

See 1 more Smart Citation

Total neoadjuvant treatment of locally advanced rectal cancer with high risk factors in Slovenia

Tuta

Boc

Brecelj

et al. 2019

Radiology and Oncology

Self Cite

View full text Add to dashboard Cite

BackgroundIn the light of a high rate of distant recurrence and poor compliance of adjuvant chemotherapy in high risk rectal cancer patients the total neoadjuvant treatment was logical approach to gaining acceptance. We aimed to evaluate toxicity and efficiency of this treatment in patients with rectal cancer and high risk factors for local or distant recurrence.Patients and methodsPatients with rectal cancer stage II and III and with at least one high risk factor: T4, presence of extramural vein invasion (EMVI), positive extramesorectal lymph nodes or mesorectal fascia (MRF) involvement were treated with four cycles of induction CAPOX/FOLFOX, followed by capecitabine-based radiochemotherapy (CRT) and two consolidation cycles of CAPOX/FOLFOX before the operation. Surgery was scheduled 8–10 weeks after completition of CRT.ResultsFrom November 2016 to July 2018 66 patients were evaluable. All patients had stage III disease, 24 (36.4%) had T4 tumors, in 46 (69.7%) EMVI was present and in 47 (71.2%) MRF was involved. After induction chemotherapy, which was completed by 61 (92.4%) of patients, radiologic downstaging of T, N, stage, absence of EMVI or MRF involvement was observed in 42.4%, 62.1%, 36.4%, 69.7% and 68.2%, respectively. All patients completed radiation and 54 (81.8%) patients received both cycles of consolidation chemotherapy. Grade 3 adverse events of neoadjuvant treatment was observed in 4 (6%) patients. Five patients rejected surgery, 3 of them with radiologic complete clinical remissions. One patient did not have definitive surgery of primary tumor due to unexpected cardiac arrest few days after sigmoid colostomy formation. Among 60 operated patients pathological complete response rate was 23.3%, the rate of near complete response was 20% and in 96.7% radical resection was achieved. Pathological T, N and stage downstaging was 65%, 96.7% and 83.4%, respectively. Grade ≥ 3 perioperative complications were anastomotic leakage in 3, pelvic abscess in 1 and paralytic ileus in 2 patients. The rate of pathologic complete response (pCR) in patients irradiated with 3D conformal technique was 12.1% while with IMRT and VMAT it was 37% (p < 0.05). Hypofractionation with larger dose per fraction and simultaneous integrated boost used in the latest two was the only factor associated with pCR.ConclusionsTotal neoadjuvant treatment of high risk rectal cancer is well tolerated and highly effective with excellent tumor and node regression rate and with low toxicity rate. Longer follow up will show if this strategy will improve distant disease control and survival.

show abstract

Section: Discussioncontrasting

confidence: 56%

“…Taking into account only the high risk group of patients in the study of Golo et al , the greater efficacy of our TNT approach is even more prominent. The difference in pCR rate is 13.8% (10.5% vs 23.3%) 15…”

Section: Discussionmentioning

confidence: 91%

Total neoadjuvant treatment of locally advanced rectal cancer with high risk factors in Slovenia

Tuta

Boc

Brecelj

et al. 2019

Radiology and Oncology

Self Cite

View full text Add to dashboard Cite

show abstract

“…In six of the included studies this was given before nCRT. One study administered one cycle of induction chemotherapy before nCRT and two cycles after nCRT. A variety of induction chemotherapy regimens was used, CAPOX (capecitabine–oxaliplatin) being the most common (5 studies).…”

Section: Resultsmentioning

confidence: 99%

“…The compliance rate (94 versus 57 per cent respectively; P = 0·001) and toxicity profile (19 versus 54 per cent grade 3/4 toxicities; P = 0·004) were far superior in the NAC arm. Golo and colleagues administered one cycle of induction chemotherapy before nCRT and two cycles after nCRT, with reported compliance rates of 86 and 94 per cent respectively. The remaining three studies included administered chemotherapy after CRT.…”

Section: Discussionmentioning

confidence: 99%

Systematic review of outcomes after total neoadjuvant therapy for locally advanced rectal cancer

Zaborowski

Stakelum

Winter

2019

British Journal of Surgery

View full text Add to dashboard Cite

Background Advances in surgical technique and the development of combined‐modality therapy have led to significantly improved local control in rectal cancer. Distant failure rates however, remain high, ranging between 20 and 30 per cent. Additional systemic chemotherapy in the preoperative period has been proposed as a means of eradicating subclinical micrometastases and improving long‐term survival. The purpose of this systematic review was to evaluate the current evidence regarding induction chemotherapy in combination with standard neoadjuvant chemoradiotherapy, in terms of oncological outcomes, in patients with rectal cancer. Methods A systematic review of the literature was performed to evaluate oncological outcomes and survival in patients with rectal cancer who underwent induction chemotherapy and neoadjuvant chemoradiotherapy, followed by surgical resection. Four major databases (PubMed, Embase, Scopus and Cochrane) were searched. The review included all original articles published in English reporting long‐term outcomes, specifically survival data, and was limited to prospective studies only. Results A total of 686 studies were identified. After applying inclusion and exclusion criteria, ten studies involving 648 patients were included. Median follow‐up was 53·7 (range 26–80) months. Five‐year overall and disease‐free survival rates were 74·4 and 65·4 per cent respectively. Weighted mean local recurrence and distant failure rates were 3·5 (range 0–7) and 20·6 (range 5–31) per cent respectively. Conclusion Total neoadjuvant therapy should be considered in patients with high‐risk locally advanced rectal cancer owing to improved chemotherapy compliance and disease control. Further prospective studies are required to determine whether this approach translates into improved disease‐related survival or increases the proportion of patients suitable for non‐operative management.

show abstract

“…Even 64% of patients had Stage 3 or 4 disease, so neo-adjuvant chemotherapy (CTX) and/or radiotherapy (RT) were carried out in 59% of cases. CTX and/or RT were carried out and finished six to eight weeks before surgery, as reported by Golo et al 9. Each patient was assessed preoperatively according to the American Society of Anesthesiologists (ASA) physical status classification, which accurately predicts morbidity and mortality 10.…”

Section: Methodsmentioning

confidence: 99%

Long term survival in 200 patients with advanced stage of colorectal carcinoma and diabetes mellitus – a single institution experience

Bešič

Povsic

2019

Radiology and Oncology

View full text Add to dashboard Cite

Background Diabetes mellitus (DM) and DM related comorbidities may initiate difficulties during cancer specific treatment and may have an impact on cancer management and outcome. The aim of our study was to find out if DM in patients with advanced colorectal carcinoma (CRC) is associated with cancer-specific or overall survival. Patients and methods This study included 200 consecutive patients (131 males, 69 females, mean age 63 years) with elective CRC surgery at the Institute of Oncology Ljubljana and DM was found in 39 (19.5%) of them. Even 64% of patients had Stage 3 or 4 disease, so neo-adjuvant chemotherapy (CTX) and/or radiotherapy (RT) were carried out in 59% of cases. Data about gender, age, body mass index, presence of DM, American Society of Anesthesiologists (ASA) physical status score, stage of disease and postoperative complications were collected prospectively. Cancer-specific survival and overall survival were compared by log-rank test. Results Patients with DM had a higher ASA score, BMI, the illness marker, rate of massive bleeding, blood transfusion and longer hospital stay than those without DM. The mean follow-up period was 4.75 years. All causes mortality in patients with DM and without DM was 23% and 27%, respectively. Three-year cancer-specific survival in patients with DM and without DM was 85% and 89%, respectively (p = 0.68). Three-year overall survival in patients with DM and without DM was 82% and 84%, respectively (p = 0.63). Conclusions The presence of DM was not associated with tumor stage, disease-specific survival or overall survival in patients with advanced CRC.

show abstract

Induction chemotherapy, chemoradiotherapy and consolidation chemotherapy in preoperative treatment of rectal cancer - long-term results of phase II OIGIT-01 Trial

Cited by 23 publications

References 26 publications

Total neoadjuvant treatment of locally advanced rectal cancer with high risk factors in Slovenia

Total neoadjuvant treatment of locally advanced rectal cancer with high risk factors in Slovenia

Systematic review of outcomes after total neoadjuvant therapy for locally advanced rectal cancer

Long term survival in 200 patients with advanced stage of colorectal carcinoma and diabetes mellitus – a single institution experience

Contact Info

Product

Resources

About