No benefit of adjuvant Fluorouracil Leucovorin chemotherapy after neoadjuvant chemoradiotherapy in locally advanced cancer of the rectum (LARC): Long term results of a randomized trial (I-CNR-RT)

Sainato, A.; Nunzia, Valentina Cernusco Luna; Valentini, Vincenzo; Paoli, Antonino De; Maurizi, Enrici Riccardo; Lupattelli, Marco; Aristei, Cynthia; Vidali, Cristiana; Conti, Monica; Galardi, A.; Ponticelli, Pietro; Friso, Maria Luisa; Iannone, T.; Osti, Mattia Falchetto; Manfredi, B.; Coppola, M.; Orlandini, Cinzia; Cionini, L.

doi:10.1016/j.radonc.2014.10.006

Cited by 253 publications

(189 citation statements)

References 35 publications

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“…The findings of this report as regards prognostic factors are based on a large patient cohort, which were not the case in any of the published randomized trials on adjuvant chemotherapy in rectal cancer [21,[32][33][34]. In the PROCTOR/ SCRIPT study, only 72 patients had stage II [21].…”

Section: Discussionmentioning

confidence: 83%

Lymphovascular and perineural invasion in stage II rectal cancer: a report from the Swedish colorectal cancer registry

et al. 2016

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Background: Adjuvant chemotherapy for stage II and III rectal cancer patients is a matter of discussion. The aim of the present study was to evaluate the prognostic value of lymphovascular (LVI) and perineural (PNI) invasion in stage II rectal cancer on a national level. Materials and methods: Clinico-pathological factors associated with disease-free survival (DFS) and time to recurrence in stage II rectal cancer patients were analyzed from patient data registered in the Swedish Colorectal Cancer Registry between 2006 and 2012. Results: Of 2649 patients with TNM stage II disease, 1395 (53%) received preoperative radiotherapy and 456 (17%) preoperative chemoradiotherapy. LVI and PNI were detected in 387 (15%) and 269 (10%) patients, respectively. Adjuvant chemotherapy was planned in 14%, but more often if LVI or PNI was detected (25% and 31%, respectively, p < .001 for both). The three-year DFS and time to recurrence were 78% and 17%, respectively. Both LVI and PNI indicated worse outcome. In patients not receiving postoperative chemotherapy, the risks of recurrence after three years were 20% if LVI was seen and 22% if PNI was detected (p < .001 for both). In the absence of LVI and PNI, it was 13% and 12%, respectively. In a multivariate Cox regression analysis, patients with LVI (hazard ratio 1.44, 95% CI 1.09-1.90; p ¼ .011) and PNI (hazard ratio 1.80, 95% CI 1.34-2.43, p < .001) had significantly increased risks of recurrence. Conclusions: Stage II rectal cancer patients with LVI and PNI have an increased risk of recurrence which emphasizes the need to properly evaluate the role of adjuvant chemotherapy particularly in these subgroups.

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Section: Discussionmentioning

confidence: 83%

Lymphovascular and perineural invasion in stage II rectal cancer: a report from the Swedish colorectal cancer registry

et al. 2016

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“…Auffallend ist in allen Studien insbesondere die schlechte Compliance bezüglich der adjuvanten Chemotherapie und die hohe Rate an Patienten (27 -28 %), die nach Operation keine adjuvante Behandlung erhalten konnten. Dies gilt insbesondere für Studien, bei denen die Randomisierung vor neoadjuvanter Behandlung und Operation erfolgte [959,1031]. Zwei der vier Studien mussten wegen schlechter Rekrutierung vorzeitig geschlossen werden und sind somit für die primären Endpunkte "underpowered" [1032,1033].…”

Section: Level Of Evidenceunclassified

S3-Leitlinie – Kolorektales Karzinom

Schmiegel

Buchberger

Follmann³

et al. 2017

Z Gastroenterol

151

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“…and then were randomised into observation and postoperative chemotherapy groups [33] . The investigators found no difference in 5year survival and the distant metastases rates.…”

Section: Postoperative Chemotherapy After Neoadjuvant (Chemo)radiothementioning

confidence: 99%

Adjuvant chemotherapy for rectal cancer: Is it needed?

Milinis

Thornton

Montazeri

et al. 2015

WJCO

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Adjuvant chemotherapy has become a standard treatment of advanced rectal cancer in the West. The benefits of adjuvant chemotherapy after surgery alone have been well established. However, controversy surrounds the use adjuvant chemotherapy in patients who received preoperative chemoradiotherapy, despite it being recommended by a number of international guidelines. Results of recent multicentre randomised control trials showed no benefit of adjuvant chemotherapy in terms of survival and rates of distant metastases. However, concerns exist regarding the quality of the studies including inadequate staging modalities, out-dated chemotherapeutic regimens and surgical approaches and small sample sizes. It has become evident that not all the patients respond to adjuvant chemotherapy and more personalised approach should be employed when considering the benefits of adjuvant chemotherapy. The present review discusses the strengths and weaknesses of the current evidence-base and suggests improvements for future studies.

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No benefit of adjuvant Fluorouracil Leucovorin chemotherapy after neoadjuvant chemoradiotherapy in locally advanced cancer of the rectum (LARC): Long term results of a randomized trial (I-CNR-RT)

Cited by 253 publications

References 35 publications

Lymphovascular and perineural invasion in stage II rectal cancer: a report from the Swedish colorectal cancer registry

Lymphovascular and perineural invasion in stage II rectal cancer: a report from the Swedish colorectal cancer registry

S3-Leitlinie – Kolorektales Karzinom

Adjuvant chemotherapy for rectal cancer: Is it needed?

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