Surgical outcomes of post chemoradiotherapy unresectable locally advanced rectal cancers improve with interim chemotherapy, is FOLFIRINOX better than CAPOX?

Abstract

IntroductionColorectal cancer ranks as the fourth most common malignancy in the world (1). Rectal carcinomas present a unique problem in local management due to their anatomic peculiarity. The addition of chemotherapy to pre-operative radiotherapy (RT) has improved local control and DFS rates but has not significantly affected the distant metastatic rates and OS. Methods to reduce distant failure include the use of neo-adjuvant chemotherapy (NACT) pre or post chemo-radiotherapy (CRT) prior to surgery and early studies support these strategies in terms of increased pathological complete response (pCR) rates and R0 resection rates (2,3).

Robotic versus laparoscopic sphincter‐preserving total mesorectal excision: A propensity case‐matched analysis

“…If CRM was persistently positive, additional 4 cycles of capecitabine and oxaliplatin were administered for optimal down staging. 34 The limitation of our study is a lack of data on urologic and sexual function, which may have reflected the quality of rectal dissection, and we did not assess the cost-efficiency of robotic surgery. In conclusion, our preliminary observations suggest that L-TME and R-TME can be safely performed at high volume centres for rectal cancer with acceptable clinical and oncologic outcomes.…”

“…All patients in our study underwent restaging MRI following NACRT. If CRM was persistently positive, additional 4 cycles of capecitabine and oxaliplatin were administered for optimal down staging . The limitation of our study is a lack of data on urologic and sexual function, which may have reflected the quality of rectal dissection, and we did not assess the cost‐efficiency of robotic surgery.…”

Comparisons of Efficacy, Safety, and Cost of Chemotherapy Regimens FOLFOX4 and FOLFIRINOX in Rectal Cancer: A Randomized, Multicenter Study

“…There were more deaths in the FFIO group as compared to the FFO group. FOLFIRINOX is an aggressive regimen in rectal cancer, which has high rate of fatal chemotherapeutic treatment-emergent adverse effects [ 16 ]. In respect to selecting the FOLFIRINOX chemotherapeutic regimen, FOLFIRINOX should be used in advanced rectal cancer to control tumors.…”

“…There were fewer total cancer recurrence patients in the FFIO group than in the Control and FFO groups. The FOLFIRINOX regimen is predominantly used when patients have a high risk of metastasis [ 16 ] and was found to be safer safe than and superior to gemcitabine [ 26 ]. However, the FOLFOX4 regimen is used as the standard first-line chemotherapeutic treatment in rectal cancer [ 4 ], and surgical resection is the standard of care for rectal cancer [ 13 ].…”

“…During the diagnosis process, patients who were found to have rectal tumors and who required surgical resection were recommended for surgery. After getting written informed consent from the patients or their relatives, the patients underwent rectal surgery [ 16 ].…”