Survival After Induction Chemotherapy and Chemoradiation Versus Chemoradiation and Adjuvant Chemotherapy for Locally Advanced Rectal Cancer. (12th March 2022)

• Record Type: Journal Article
• Authors: Kim, Jin K; Marco, Michael R; Roxburgh, Campbell S D; Chen, Chin-Tung; Cercek, Andrea; Strombom, Paul; Temple, Larissa K F; Nash, Garrett M; Guillem, Jose G; Paty, Philip B; Yaeger, Rona; Stadler, Zsofia K; Gonen, Mithat; Segal, Neil H; Reidy, Diane L; Varghese, Anna; Shia, Jinru; Vakiani, Efsevia; Wu, Abraham J; Romesser, Paul B; Crane, Christopher H; Gollub, Marc J; Saltz, Leonard; Smith, J Joshua; Weiser, Martin R; Patil, Sujata; Garcia-Aguilar, Julio
• Is Part Of: Oncologist. Volume 27:Number 5(2022)
• Page Start: 380
• Page End: 388
• Publication Date: 2022-03-12
• Subjects: Total neoadjuvant therapy -- survival -- response -- locally advanced rectal cancer; Oncology -- Periodicals; Tumors -- Periodicals; Cancérologie -- Périodiques; Tumeurs -- Périodiques; Oncology; Tumors; Neoplasms; Electronic journals; Periodicals; Periodicals; 616.994
• DOI: 10.1093/oncolo/oyac025
• Languages: English
• ISSNs: 1083-7159

Abstract

Abstract : Previously reported results have shown that, compared with neoadjuvant chemoradiotherapy alone, total neoadjuvant therapy improves tumor response in locally advanced rectal cancer. This article reports results of a retrospective case series and provides updated information on tumor response and survival. Abstract: Background: Total neoadjuvant therapy (TNT) improves tumor response in locally advanced rectal cancer (LARC) patients compared to neoadjuvant chemoradiotherapy alone. The effect of TNT on patient survival has not been fully investigated. Materials and Methods: This was a retrospective case series of patients with LARC at a comprehensive cancer center. Three hundred and eleven patients received chemoradiotherapy (chemoRT) as the sole neoadjuvant treatment and planned adjuvant chemotherapy, and 313 received TNT (induction fluorouracil and oxaliplatin-based chemotherapy followed by chemoradiotherapy in the neoadjuvant setting). These patients then underwent total mesorectal excision or were entered in a watch-and-wait protocol. The proportion of patients with complete response (CR) after neoadjuvant therapy (defined as pathological CR or clinical CR sustained for 2 years) was compared by the χ 2 test. Disease-free survival (DFS), local recurrence-free survival, distant metastasis-free survival, and overall survival were assessed by Kaplan-Meier analysis and log-rank test. Cox regression models were used to further evaluate DFS. Results: The rate of CR was 20% for chemoRT and 27% for TNT ( P =.05). DFS, local recurrence-free survival, metastasis-free survival, and overall survival were no different. Disease-free survival was not associated with the type of neoadjuvant treatment (hazard ratio [HR] 1.3; 95% confidence interval [CI] 0.93-1.80; P = .12). Conclusions: Although TNT does not prolong survival than neoadjuvant chemoradiotherapy plus intended postoperative chemotherapy, the higher response rate associated with TNT may create opportunities to preserve the rectum in more patients with LARC.