Oxaliplatin-based adjuvant chemotherapy without radiotherapy can improve the survival of locally-advanced rectal cancer.

Jun Li,Ke-Feng Ding,Ye-Ting Hu,Xiu-Yan Yu,Su-Zhan Zhang,Jian-Wei Wang,Ying Yuan,Yue Liu,Yang Gao,Jin-Jie He,Han-Guang Hu,Wenyu Lin

doi:10.1371/journal.pone.0107872

Abstract

ObjectiveTo assess the impact of oxaliplatin-containing adjuvant chemotherapy on the survival of patients with locally-advanced rectal cancer.MethodsData on patients with pathologically-confirmed T3/4 or N1/2 rectal cancer who accepted radical surgery at our center from January 2002 to June 2009 were reviewed retrospectively. The patients' 5-year overall survival (OS), disease-specific survival (DSS), and recurrence-free survival (RFS) were analyzed by comparing those who accepted radical surgery only (Group S) with those who accepted radical surgery and oxaliplatin-containing adjuvant chemotherapy (Group SO).ResultsA total of 236 patients were analyzed (Group S 135; Group SO 101). Group S patients were older and had a higher proportion with stage II disease and more perioperative complications than those in Group SO (P<0.05). The OS and DSS of patients with stage III disease under 50 years of age or with mucinous adenocarcinoma were higher in Group SO than Group S (P<0.05). In addition, the OS of patients with stage N2b disease was higher in Group SO than Group S (P = 0.016), and the OS of patients with stage N1a or N2b disease who received more than 8 weeks of oxaliplatin-containing chemotherapy was also higher in Group SO than Group S (P<0.05). Although the OS and DSS of patients with stage II disease in Group SO showed a tendency towards improvement, the differences between the groups were not statistically significant.ConclusionAdjuvant oxaliplatin-containing chemotherapy can improve the survival of patients with locally-advanced low and middle rectal cancers in comparison with observation. Randomized, prospective trials are warranted to confirm this benefit of oxaliplatin for rectal cancer.

Highlights

There are obvious differences in adjuvant therapy schedules between colon cancer and rectal cancer
Adjuvant oxaliplatin-containing chemotherapy can improve the survival of patients with locally-advanced low and middle rectal cancers in comparison with observation
Randomized, prospective trials are warranted to confirm this benefit of oxaliplatin for rectal cancer

Summary

Introduction

There are obvious differences in adjuvant therapy schedules between colon cancer and rectal cancer. Chemotherapy regimens containing oxaliplatin, such as FOLFOX and XELOX, have been the standard adjuvant therapy for advanced colon cancer for some time [1,2,3]. The postoperative use of oxaliplatin in rectal cancer resulted from an extrapolation of the available data in colon cancer. 2 phase III trials in patients with locally-advanced rectal cancer reported that the addition of oxaliplatin to the standard of 5-FU or capecitabine and radiation did not result in an increased tumor response but did cause greater toxicity [7,8]. No trials have assessed the effect of single adjuvant chemotherapy regimens containing oxaliplatin for rectal cancer as the key role of radiotherapy was established 2 decades ago

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Conclusion