Abstract
Background: For Stage II/III rectal cancer patients, curative resection is the primary treatment, prescribing of postoperative adjuvant chemotherapy (PAC) is regarded as a standard therapy. The interval between surgery and the initiation of PAC is usually within 8 weeks. However, the optimal cut-off is still controversial. This study aimed to explore the impact of extremely early initiation of PAC for II/III rectal cancer. Methods: Patients with Stage II/III rectal cancer treated from January 2013 to December 2015 were retrospectively collected at the Department of Tongji Hospital. According to the starting point of PAC, patients were categorized into two groups: extremely early group (The interval of PAC ≤ 2 weeks) and normal group (The interval of PAC within 3 - 5 weeks). For the sake of evaluating the effectiveness of different intervals, Overall Survival rate (OS), Progress-Free Survival rate (PFS) and Recurrence or Metastasis Rate (RMR) were analyzed, as well as the Quality of Life Score. To estimate the safety of the extremely early PAC, we evaluated the first post chemotherapy adverse reactions and defecation ability, and analyzed the variance laboratory indexes around the first postoperative adjuvant chemotherapy. Results: A total of 267 patients were included in this study. Compared to normal group (192 cases), extremely early group (75 cases) of patients attained a better tendency of OS and PFS, although there were no significant statistical differences (OS: P = 0.0930; PFS: P = 0.1058). However, the RMR was significant lower (P = 0.0452) and the Quality of Life Score was significantly higher (P = 0.0090) in extremely early group. Multivariate analysis also showed that extremely early group had better defecation ability (P = 0.0149) and less side reactions of post chemotherapy, such as vomiting (P , got a higher level of inflammatory cells (P Conclusion: For Stage II/III rectal cancer patients, extremely early to start PAC not only might be effectively prolonging the survival, but indeed decrease the tumor-related recurrence risk, increase the quality of life and decrease chemotherapy-associated adverse reactions. Meanwhile, appropriately controlling of inflammatory cells and protecting the liver function should be of concern to ensure the safety of early initial stage.
Highlights
Rectal cancer is a very heterogeneous disease caused by the interaction of genetic and environmental factors [1], which is the third commonest cause of cancer and the fourth commonest cause of cancer death all over the world [2]
A large, randomized study conducted with Stage II/III CRC patients in the Hospital Episode Statistics (HES) reported that postoperative adjuvant chemotherapy (PAC) initiation beyond 8 weeks significantly reduced overall survival (OS) in patients, compared to those who received it within 8 weeks, and every 2 weeks increments in the delay accompanied by progressively worse OS [7]
There was no significant difference in gender or age between two groups
Summary
Rectal cancer is a very heterogeneous disease caused by the interaction of genetic and environmental factors [1], which is the third commonest cause of cancer and the fourth commonest cause of cancer death all over the world [2]. A large, randomized study conducted with Stage II/III CRC patients in the Hospital Episode Statistics (HES) reported that PAC initiation beyond 8 weeks significantly reduced overall survival (OS) in patients, compared to those who received it within 8 weeks, and every 2 weeks increments in the delay accompanied by progressively worse OS [7]. For Stage II/III rectal cancer patients, curative resection is the primary treatment, prescribing of postoperative adjuvant chemotherapy (PAC) is regarded as a standard therapy. Conclusion: For Stage II/III rectal cancer patients, extremely early to start PAC might be effectively prolonging the survival, but decrease the tumor-related recurrence risk, increase the quality of life and decrease chemotherapy-associated adverse reactions. Appropriately controlling of inflammatory cells and protecting the liver function should be of concern to ensure the safety of early initial stage
Sign-in/Register to view highlights & summary Sign-in/Register to access full text options 
Talk to us
Join us for a 30 min session where you can share your feedback and ask us any queries you have
Schedule a callDisclaimer: All third-party content on this website/platform is and will remain the property of their respective owners and is provided on "as is" basis without any warranties, express or implied. Use of third-party content does not indicate any affiliation, sponsorship with or endorsement by them. Any references to third-party content is to identify the corresponding services and shall be considered fair use under The CopyrightLaw.
