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International Journal of Colorectal Disease

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01-06-2016 | Original Article

Is adjuvant chemotherapy necessary for patients with pathological complete response after neoadjuvant chemoradiotherapy and radical surgery in locally advanced rectal cancer? Long-term analysis of 40 ypCR patients at a single center

Authors: Jiaolin Zhou, Huizhong Qiu, Guole Lin, Yi Xiao, Bin Wu, Wenming Wu, Xiyu Sun, Junyang Lu, Guannan Zhang, Lai Xu, Yuchao Liu

Published in: International Journal of Colorectal Disease | Issue 6/2016

Abstract

Objectives

According to practice guidelines, adjuvant chemotherapy (ACT) is required for all patients with locally advanced rectal cancer who have received neoadjuvant chemoradiotherapy (NCRT) and total mesorectal excision (TME). The objective of this study was to determine whether ACT is necessary for patients achieving pathological complete response (pCR) after NCRT followed by surgery.

Methods

By retrospectively reviewing a prospectively collected database in our single tertiary care center, 210 patients with locally advanced rectal cancer who underwent NCRT followed by TME were identified between February 2005 and August 2013. All patients achieving ypCR were enrolled in this study, in which who underwent ACT (chemo group) and who did not (non-chemo group) were compared in terms of local recurrence (LR) rate, 5-year disease-free survival (DFS) rate and overall survival (OS) rate.

Results

Forty consecutive patients with ypCR were enrolled, 19 (47.5 %) in chemo group and 21 (52.5 %) in non-chemo group. After a median follow-up of 57 months, five patients developed systemic recurrences, with the 5y-DFS rate of 83.5 %. No LR occurred in the two groups. The 5y-DFS rates for patients in chemo group and non-chemo group was 90.9 and 76.0 %, respectively, showing no statistically significant difference (p = 0.142). Multivariate analysis showed that tumor grade was the only independent prognostic factor for 5y-DFS and 5y-OS.

Conclusions

Results of this study suggested that it may not be necessary for all rectal cancer patients with ypCR after NCRT and radical surgery to receive ACT. Prospective randomized trials are warranted to further determine the value of ACT for ypCR patients.

Scott NA, Susnerwala S, Gollins S et al (2009) Preoperative neo-adjuvant therapy for curable rectal cancer--reaching a consensus 2008. Colorectal Dis 11:245–248CrossRefPubMed

Glimelius B, Oliveira J (2009) Rectal cancer: ESMO clinical recommendations for diagnosis, treatment and follow-up. Ann Oncol 20(Suppl 4):54–56PubMed

Capirci C, Valentini V, Cionini L et al (2008) Prognostic value of pathologic complete response after neoadjuvant therapy in locally advanced rectal cancer: long-term analysis of 566 ypCR patients. Int J Radiat Oncol Biol Phys 72:99–107CrossRefPubMed

Maas M, Nelemans PJ, Valentini V et al (2010) Long-term outcome in patients with a pathological complete response after chemoradiation for rectal cancer: a pooled analysis of individual patient data. Lancet Oncol 11:835–844CrossRefPubMed

Valentini V, van Stiphout RG, Lammering G et al (2015) Selection of appropriate end-points (pCR vs 2yDFS) for tailoring treatments with prediction models in locally advanced rectal cancer. Radiother Oncol 114:302–309CrossRefPubMed

Benson AB 3rd, Bekaii-Saab T, Chan E et al (2012) Rectal cancer. J Natl Compr Canc Netw 10:1528–1564PubMed

Collette L, Bosset JF, den Dulk M et al (2007) Patients with curative resection of cT3-4 rectal cancer after preoperative radiotherapy or radiochemotherapy: does anybody benefit from adjuvant fluorouracil-based chemotherapy? A trial of the European Organisation for Research and Treatment of Cancer Radiation Oncology Group. J Clin Oncol 25:4379–4386CrossRefPubMed

Fietkau R, Barten M, Klautke G et al (2006) Postoperative chemotherapy may not be necessary for patients with ypN0-category after neoadjuvant chemoradiotherapy of rectal cancer. Dis Colon Rectum 49:1284–1292CrossRefPubMed

Jung KU, Kim HC, Park JO et al (2015) Adjuvant chemotherapy after neoadjuvant chemoradiation and curative resection for rectal cancer: is it necessary for all patients? J Surg Oncol 111:439–444CrossRefPubMed

10.

Park IJ, Kim DY, Kim HC et al (2015) Role of adjuvant chemotherapy in ypT0-2N0 patients treated with preoperative chemoradiation therapy and radical resection for rectal cancer. Int J Radiat Oncol Biol Phys 92:540–547CrossRefPubMed

11.

Breugom AJ, Swets M, Bosset JF et al (2015) Adjuvant chemotherapy after preoperative (chemo)radiotherapy and surgery for patients with rectal cancer: a systematic review and meta-analysis of individual patient data. Lancet Oncol 16:200–207CrossRefPubMed

12.

Garcia-Albeniz X, Gallego R, Hofheinz RD et al (2014) Adjuvant therapy sparing in rectal cancer achieving complete response after chemoradiation. World J Gastroenterol 20:15820–15829CrossRefPubMedPubMedCentral

13.

De Stefano A, Moretto R, Bucci L et al (2014) Adjuvant treatment for locally advanced rectal cancer patients after preoperative chemoradiotherapy: when, and for whom? Clin Colorectal Cancer 13:185–191CrossRefPubMed

14.

Kiran RP, Kirat HT, Burgess AN et al (2012) Is adjuvant chemotherapy really needed after curative surgery for rectal cancer patients who are node-negative after neoadjuvant chemoradiotherapy? Ann Surg Oncol 19:1206–1212CrossRefPubMed

15.

Haynes AB, You YN, Hu CY et al (2014) Postoperative chemotherapy use after neoadjuvant chemoradiotherapy for rectal cancer: analysis of surveillance, epidemiology, and end results-Medicare data, 1998–2007. Cancer 120:1162–1170CrossRefPubMedPubMedCentral

16.

Bosset JF, Collette L, Calais G et al (2006) Chemotherapy with preoperative radiotherapy in rectal cancer. N Engl J Med 355:1114–1123CrossRefPubMed

17.

Bosset JF, Calais G, Mineur L et al (2014) Fluorouracil-based adjuvant chemotherapy after preoperative chemoradiotherapy in rectal cancer: long-term results of the EORTC 22921 randomised study. Lancet Oncol 15:184–190CrossRefPubMed

18.

Ahn DH, Wu C, Wei L et al (2015) The efficacy of adjuvant chemotherapy in patients with stage II/III resected rectal cancer treated with neoadjuvant chemoradiation therapy. Am J Clin Oncol. doi:10.1097/COC.0000000000000185

19.

Chang GJ PI, Eng C (2012) Exploratory analysis of adjuvant chemotherapy benefits after preoperative chemoradiotherapy and radical resection for rectal cancer. J Clin Oncol 30:abstr 557CrossRef

20.

Scholefield JH, Steele RJ (2002) Guidelines for follow up after resection of colorectal cancer. Gut 51(Suppl 5):V3–V5CrossRefPubMedPubMedCentral

21.

Umpleby HC, Fermor B, Symes MO, Williamson RC (1984) Viability of exfoliated colorectal carcinoma cells. Br J Surg 71:659–663CrossRefPubMed

22.

Habr-Gama A, Perez RO, Proscurshim I et al (2006) Patterns of failure and survival for nonoperative treatment of stage c0 distal rectal cancer following neoadjuvant chemoradiation therapy. J Gastrointest Surg 10:1319–1328, discussion 1328–1319CrossRefPubMed

Title: Is adjuvant chemotherapy necessary for patients with pathological complete response after neoadjuvant chemoradiotherapy and radical surgery in locally advanced rectal cancer? Long-term analysis of 40 ypCR patients at a single center
Authors: Jiaolin Zhou
Huizhong Qiu
Guole Lin
Yi Xiao
Bin Wu
Wenming Wu
Xiyu Sun
Junyang Lu
Guannan Zhang
Lai Xu
Yuchao Liu
Publication date: 01-06-2016
Publisher: Springer Berlin Heidelberg
Published in: International Journal of Colorectal Disease / Issue 6/2016
Print ISSN: 0179-1958
Electronic ISSN: 1432-1262
DOI: https://doi.org/10.1007/s00384-016-2579-5

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Is adjuvant chemotherapy necessary for patients with pathological complete response after neoadjuvant chemoradiotherapy and radical surgery in locally advanced rectal cancer? Long-term analysis of 40 ypCR patients at a single center

Abstract

Objectives

Methods

Results

Conclusions

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Abstract

Objectives

Methods

Results

Conclusions

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