Abstract
AimTo determine whether adding consolidation capecitabine chemotherapy without lengthening the waiting period influences pathological complete response (pCR) and short-term outcome of locally advanced rectal cancer (LARC) receiving neoadjuvant chemoradiotherapy (NCRT).MethodTotally, 545 LARC who received NCRT and radical resection between 2010 and 2018 were enrolled. Short-term outcome and pCR rate were compared between patients with and without additional consolidation capecitabine. Logistic analysis was performed to identify predictors of pCR.ResultsAfter propensity score matching, 229 patients were matched in both NCRT and NCRT-Cape groups. Postoperative morbidity was comparable between groups except for operation time, which is lower in the NCRT group (213.2 ± 67.4 vs. 227.9 ± 70.5, p = 0.025). Two groups achieved similar pCR rates (21.8 vs. 22.7%, p = 1.000). Tumor size (OR = 0.439, p < 0.001), time interval between NCRT and surgery (OR = 1.241, p = 0.003), and post-NCRT carcinoembryonic antigen (OR = 0.880, p = 0.008) were significantly correlated with pCR in patients with LARC. A predictive nomogram was constructed with a C-index of 0.787 and 0.741 on internal and external validation.ConclusionAdding consolidation capecitabine chemotherapy without lengthening CRT-to-surgery interval in LARC patients after NCRT does not seem to impact pCR or short-term outcome. A predictive nomogram for pCR was successful, and it could support treatment decision-making.
Highlights
Neoadjuvant chemoradiotherapy (NCRT) and radical surgery have become the standard treatment for locally advanced rectal cancer (LARC) [1]
Increasing pathological complete response (pCR) rate has become a primary endpoint of clinical trials, which might increase patients with LARC who could potentially benefit from organ-preservation strategies
229 patients receiving standard NCRT (NCRT group) and 229 patients treated with NCRT and additional 2 cycles of consolidation capecitabine chemotherapy (NCRT-Cape group) were matched
Summary
Neoadjuvant chemoradiotherapy (NCRT) and radical surgery have become the standard treatment for locally advanced rectal cancer (LARC) [1]. The benefits of this multimodal treatment have been well-documented, namely, tumor downsizing and downstaging, increased radical resection rate, and better local tumor control [2,3,4]. Increasing pCR rate has become a primary endpoint of clinical trials, which might increase patients with LARC who could potentially benefit from organ-preservation strategies. Many strategies have been adopted to maximize the pCR rate, namely, dose-escalated radiation [8], intensified neoadjuvant treatment [induction [9] or consolidation chemotherapy [1, 8, 10,11,12,13,14,15,16]], and lengthening the CRT-to-surgery interval [17]
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