Outcomes of neoadjuvant chemoradiotherapy in Japanese locally advanced rectal carcinoma patients

Abstract

BackgroundWe investigated the efficacy and prognosis of neoadjuvant chemoradiotherapy (NACRT) for Japanese locally advanced rectal carcinoma patients.MethodsFifty-seven patients diagnosed with cT3-4 or any cT/cN+ disease using enhanced computed tomography or magnetic resonance imaging from 2002 to 2014 were enrolled. The male/female ratio was 42/15, and the median age was 67 years. Ra/Rb/Rb-P/P was expressed by 6/35/14/2 patients. Histological tumor types were tub1/tub2/por/muc in 22/30/4/1 patients. For NACRT, radiotherapy doses were 40–50.4 Gy chemotherapy consisted of 5′-DFUR, capecitabine, or S1.ResultsAll 57 patients received curative surgical treatment. The anal preservation rate was 65.0 %. The ypStage of 0/I/II/IIIa/IIIb was 7/10/25/11/4 cases. The histological antitumor effect (HATE) was ≥grade (G) 2 and G3 in 31 (54.4 %) and 7 (12.3 %) cases, respectively. Postoperative complications occurred in 17 patients and exceeded GIII (Clavien–Dindo classification) in four patients. Recurrence was observed in 19 patients; the primary local recurrence rate was 5.3 %. The 3-year relapse-free survival (RFS) and overall survival (OS) rates were 64.8 and 95.5 %, respectively; the 5-year RFS and OS rates were 60.2 and 61.0 %, respectively. In multivariate analysis, ypN+ was a high-risk factor for distant organ recurrence. As predictive factors regarding the efficacy of NACRT, a neutrophil concentration <70 % and a neutrophil/lymphocyte ratio <3.0 in peripheral blood prior to treatment indicated that NACRT would be significantly more effective.ConclusionsNACRT was effective in reducing local recurrence but did not suppress distant organ recurrence in Japanese locally advanced rectal carcinoma patients. A further investigation of an extension of the NACRT regimen is required.

Feasibility and Efficacy of Neoadjuvant Chemotherapy without Radiotherapy for Locally Advanced Rectal Cancer

“…In the present study, the R0 operation rate (primary endpoint) and R1 operation rate were 90% and 10%, respectively. The R1 operation rate was relatively higher than NACRT in our previous report [13]. This outcome may indicate that the local control power of NAC without radiotherapy may be insufficient.…”

“…So far, in our institution, we have introduced NACRT. However, the long-term outcomes, such as the 5-year relapse-free survival (RFS) and 5-year overall survival (OS), were not improved by NACRT [13]. We considered that NAC for LARC might be effective in improving the RFS and OS by controlling distant micrometastases.…”

“…In our institute, we previously administered NACRT for LARC in accordance with the data from Western countries. However, although NACRT exerted local control effects, it did not contribute to improved long-term prognosis in LARC [13]. Therefore, we changed our treatment strategy for LARC from NACRT to NAC, beginning in April 2014, to improve long-term outcomes, such as overall survival and relapse-free survival.…”

Emerging roles of non‑coding RNAs in the response of rectal cancer to radiotherapy (Review)

“…The application of nCRT to Japanese patients with LARC has met several obstacles. Normally, Japanese people are thinner and with less visceral fat than individuals in Western countries and the USA, therefore making surgery a favorable choice (60). Another reason is the lack of radiation oncologists, RT technologists and medical physicists in Japan, resulting in the rate of new patients with cancer who receive RT being less than half of that in Western countries (61,62).…”

Clinicopathological, genomic and immunological factors in colorectal cancer prognosis

“…There are therefore differences in its application across the world. In the USA and Europe, the most common approach is preoperative short‐course radiotherapy; however, in Japan this is not standard practice. In England, wide variation has been demonstrated in the use of radiotherapy, with men and patients having an abdominoperineal excision receiving it more often, and elderly patients and those with co‐morbidities less so.…”