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Strahlentherapie und Onkologie
Published in: Strahlentherapie und Onkologie 2/2014

01-02-2014 | Original article

Preoperative chemoradiation with or without induction oxaliplatin plus 5-fluorouracil in locally advanced rectal cancer

Long-term outcome analysis

Authors: F.A. Calvo, M.D., Ph.D., Dr. C.V. Sole, M.D., J. Serrano, M.D., Ph.D., E. del Valle, M.D., M. Rodriguez, M.D., A. Muñoz-Calero, M.D., J.L. García-Sabrido, M.D., Ph.D., P. Garcia-Alfonso, M.D., I. Peligros, M.D., E. Alvarez, M.D.

Published in: Strahlentherapie und Onkologie | Issue 2/2014

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Abstract

Background and purpose

It has been previously reported that a short FOLFOX-4 induction significantly improves pathologic complete response in locally advanced rectal cancer (LARC) patients treated with preoperative chemoradiation (CRT). In a larger and updated patient series, we analyzed FOLFOX-4 efficacy in terms of sphincter preservation and long-term outcomes.

Patients and methods

From January 1995 to December 2010, 335 LARC patients were treated with preoperative chemoradiation (4500–5040 cGy). Starting in May 2001, 207 consecutive patients additionally received induction FOLFOX-4. Surgery was performed 6 weeks (range 3–12 weeks) after chemoradiation.

Results

Incidence of total tumor (63 vs. 54 %, p = 0.02) and nodal downstaging (60 vs. 43 %, p = 0.002) was significantly increased by induction FOLFOX-4. In an analysis of tumors located below 5 cm from the anal verge (n = 114, 34 %), sphincter preservation was feasible in 30 % in the FOLFOX-4 versus 13 % in the upfront CRT group (p = 0.04). Median follow-up time for the entire cohort of patients was 72.6 months (range 4–205 months). FOLFOX-4 was not associated with superior locoregional control (HR 0.88, p = 0.78), disease-free survival (HR 0.83, p = 0.55), distant metastases-free survival (HR 0.94, p = 0.81), or cancer-specific survival (HR 0.70, p = 0.15).

Conclusion

Short-intense induction FOLFOX-4 significantly improves downstaging and sphincter preservation in low rectal tumors. Long-term outcomes were not improved in the FOLFOX-4 group of patients.
Literature
1.
Sauer R, Liersch T, Merkel S et al (2012) Preoperative versus postoperative chemoradiotherapy for locally advanced rectal cancer: results of the German CAO/ARO/AIO-94 randomized phase III trial after a median follow-up of 11 years. J Clin Oncol 30:1926–1933PubMedCrossRef
2.
Gijn W van, Marijnen CA, Nagtegaal ID et al (2011) Preoperative radiotherapy combined with total mesorectal excision for resectable rectal cancer: 12-year follow-up of the multicentre, randomised controlled TME trial. Lancet Oncol 12:575–582PubMedCrossRef
3.
Guckenberger M, Saur G, Wehner D et al (2012) Comparison of preoperative short course radiotherapy and long-course radiochemotherapy for locally advanced rectal cancer. Strahlenther Onkol 188:551–557PubMedCrossRef
4.
Sautter-Bihl ML, Hohenberger W, Fietkau R et al (2013) Rectal cancer: when is the local recurrence risk low enough to refrain from the aim to prevent it? Strahlenther Onkol 189:105–110PubMedCrossRef
5.
Sauer R, Becker H, Hohenberger W et al (2004) Preoperative versus postoperative chemoradiotherapy for rectal cancer. N Engl J Med 351:1731–1740PubMedCrossRef
6.
Bujko K, Nowacki MP, Nasierowska-Guttmejer A et al (2004) Sphincter preservation following preoperative radiotherapy for rectal cancer: report of a randomised trial comparing short-term radiotherapy vs. conventionally fractionated radiochemotherapy. Radiother Oncol 72:15–24PubMedCrossRef
7.
Gerard JP, Azria D, Gourgou-Bourgade S et al (2010) Comparison of two neoadjuvant chemoradiotherapy regimens for locally advanced rectal cancer: results of the phase III trial ACCORD 12/0405-Prodige 2. J Clin Oncol 28:1638–1644PubMedCrossRef
8.
Rödel C, Liersch T, Becker H et al (2012) Preoperative chemoradiotherapy and postoperative chemotherapy with fluorouracil and oxaliplatin versus fluorouracil alone in locally advanced rectal cancer: initial results of the German CAO/ARO/AIO-04 randomised phase 3 trial. Lancet Oncol 13:679–687PubMedCrossRef
9.
Calvo FA, Serrano FJ, Diaz-González JA et al (2006) Improved incidence of pT0 downstaged surgical specimens in locally advanced rectal cancer (LARC) treated with induction oxaliplatin plus 5-fluorouracil and preoperative chemoradiation. Ann Oncol 17:1103–1110PubMedCrossRef
10.
Quirke P, Durdey P, Dixon MF, Williams NS (1986) Local recurrence of rectal adenocarcinoma due to inadequate surgical resection, histopathological study of lateral tumor spread and surgical excision. Lancet 2:996–999PubMedCrossRef
11.
American Joint Committee on Cancer (2007) General information on cancer staging and end-results reporting. In: Cancer staging handbook, 7th edn. Springer, Heidelberg, pp 1–39
12.
Rodel C, Martus P, Papadoupolos T et al (2005) Prognostic significance of tumor regression after preoperative chemoradiotherapy for rectal cancer. J Clin Oncol 23:8688–8696PubMedCrossRef
13.
Crane CH, Skibber JM, Feig BW et al (2003) Response to preoperative chemoradiation increase the use of sphincter preserving surgery in patients with locally advanced low rectal carcinoma. Cancer 97:517–524PubMedCrossRef
14.
Glehen O, Chapet O, Adham M et al (2003) Long-term results of the Lyons R90-01 randomized trail of preoperative radiotherapy and delayed surgery and its effect on sphincter-saving surgery in rectal cancer. Br J Surg 90:996–998PubMedCrossRef
15.
Jakobsen A, Ploen J, Vuong T et al (2012) Dose–effect relationship in chemoradiotherapy for locally advanced rectal cancer: a randomized trial comparing two radiation doses. Int J Radiat Oncol Biol Phys 84:949–954PubMedCrossRef
16.
Gerard JP, Chapet O, Nemoz C et al (2004) Improved sphincter preservation in low rectal cancer with high-dose preoperative radiotherapy: the Lyon R96-02 randomized trial. J Clin Oncol 22:2404–2409PubMedCrossRef
17.
Glynne-Jones R, Grainger J, Harrison M et al (2006) Neoadjuvant chemotherapy prior to preoperative chemoradiation or radiation in rectal cancer: should we be more cautious? Br J Cancer 94:363–371PubMedCentralPubMedCrossRef
18.
Chua YJ, Barbachano Y, Cunningham D et al (2010) Neoadjuvant capecitabine and oxaliplatin before chemoradiotherapy and total mesorectal excision in MRI defined poor-risk rectal cancer: a phase 2 trial. Lancet Oncol 11:241–248PubMedCrossRef
19.
Rödel C, Arnold D, Becker H et al (2010) Induction chemotherapy before chemoradiotherapy and surgery for locally advanced rectal cancer: is it time for a randomized phase III trial? Strahlenther Onkol 186:658–664PubMedCrossRef
20.
Fernandez-Martos C, Pericay C, Aparicio J et al (2010) Phase II, randomized study of concomitant chemoradiotherapy followed by surgery and adjuvant capecitabine plus oxaliplatin (CAPOX) compared with induction CAPOX followed by concomitant chemoradiotherapy and surgery in magnetic resonance imaging-defined, locally advanced rectal cancer: Grupo cancer de recto 3 study. J Clin Oncol 28:859–865PubMedCrossRef
21.
Maréchal R, Vos B, Polus M et al (2012) Short course chemotherapy followed by concomitant chemoradiotherapy and surgery in locally advanced rectal cancer: a randomized multicentric phase II study. Ann Oncol 23:1525–1530PubMedCrossRef
22.
Roh MS, Colangelo LH, O’Connell MJ et al (2009) Preoperative multimodality therapy improves disease-free survival in patients with carcinoma of the rectum: NSABP R-03. J Clin Oncol 27:5124–5130PubMedCrossRef
23.
Bujko K, Richter P, Smith FM et al (2013) Preoperative radiotherapy and local excision of rectal cancer with immediate radical re-operation for poor responders: a prospective multicentre study. Radiother Oncol 106:198–205PubMedCrossRef
24.
Glynne-Jones R, Anyamene N, Moran B, Harrison M (2012) Neoadjuvant chemotherapy in MRI-staged high-risk rectal cancer in addition to or as an alternative to preoperative chemoradiation? Ann Oncol 23:2517–2526PubMedCrossRef
Metadata
Title
Preoperative chemoradiation with or without induction oxaliplatin plus 5-fluorouracil in locally advanced rectal cancer
Long-term outcome analysis
Authors
F.A. Calvo, M.D., Ph.D.
Dr. C.V. Sole, M.D.
J. Serrano, M.D., Ph.D.
E. del Valle, M.D.
M. Rodriguez, M.D.
A. Muñoz-Calero, M.D.
J.L. García-Sabrido, M.D., Ph.D.
P. Garcia-Alfonso, M.D.
I. Peligros, M.D.
E. Alvarez, M.D.
Publication date
01-02-2014
Publisher
Springer Berlin Heidelberg
Published in
Strahlentherapie und Onkologie / Issue 2/2014
Print ISSN: 0179-7158
Electronic ISSN: 1439-099X
DOI
https://doi.org/10.1007/s00066-013-0469-0

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