Abstract
BackgroundNeoadjuvant chemoradiotherapy (NACRT) has now become the standard treatment for locally advanced rectal cancer (LARC). NACRT has decreased local relapse (LR) rate in patients with LARC; however, distant relapse has recently attracted much attention. This study aimed to assess the feasibility and efficiency of neoadjuvant chemotherapy (NAC) for LARC.MethodsData on patients with cT3/4 and N+ rectal cancer who were treated in our institution from April 2010 to February 2016 were reviewed retrospectively. Twenty-seven patients who received 2–9 cycles of oxaliplatin-based NAC and 28 patients who received NACRT (45 Gy delivered in 25 fractions and 5-fluorouracil-based oral chemotherapy) were analyzed. The primary and secondary endpoints of the present study were the 3-year relapse-free survival (RFS) and the local and distant relapse rates, respectively.ResultsRegardless of the kind of neoadjuvant therapy, no patient experienced any grade 3–4 therapy-related adverse events. The frequent toxic events were grade 1 diarrhea in patients with NACRT and neutropenia in patients with NAC. A significantly higher proportion of patients with NAC underwent laparoscopic surgery and anterior resection (p = 0.037 and p = 0.003, respectively). The percentages of patients with lymph node yield less than 12 in the NAC group, and those in the NACRT group were 26 and 68%, respectively (p = 0.002). Comparing the NAC with the NACRT groups, the local relapse and distant relapse rates were 7.4 and 7.1% and 7.4 and 18%, respectively. There were no significant differences in 3-year RFS and 4-year overall survival (OS) between NAC and NACRT (3-year RFS 85.2 vs. 70.4%, p = 0.279; 4-year OS 96.3 vs. 89.1%, p = 0.145, respectively). With an analysis excluding patients who received postoperative adjuvant chemotherapy, no patients who received NAC had a distant relapse, and there was a significant difference in 3-year RFS compared with the NACRT groups (94.4 vs. 63.2%, p = 0.043).ConclusionThese outcomes suggest that the therapeutic effect of oxaliplatin-based NAC is at least equal to that of NACRT and that NAC is a feasible and promising option for LARC.
Highlights
Neoadjuvant chemoradiotherapy (NACRT) has become the standard treatment for locally advanced rectal cancer (LARC)
There were no significant differences in other clinicopathological characteristics including age, sex, pre-treatment serum Carcinoembryonic antigen (CEA) level, tumor size, distance from the anal verge, tumor differentiation, clinical-T and clinical-N category, Lateral pelvic lymph node dissection (LPLND), and postoperative adjuvant chemotherapy
Except for the abovementioned factors, there were no significant differences in almost all factors, including normalization of CEA values post neoadjuvant therapy (NAT), Response Evaluation Criteria in Solid (RECIST) evaluation, pathological grade, distance from anal verge after NAT, circumferential resection margin (CRM), lymphovascular invasion, improved invasion, and lymph node metastasis, pLPLN metastasis, and ypStage
Summary
Neoadjuvant chemoradiotherapy (NACRT) has become the standard treatment for locally advanced rectal cancer (LARC). NACRT has decreased local relapse (LR) rate in patients with LARC; distant relapse has recently attracted much attention. In Western countries, neoadjuvant chemoradiotherapy (NACRT) followed by total mesorectal excision (TME) is currently the standard treatment option for patients with LARC [1]. It is well known that, NACRT reduces the local recurrence to a rate less than 10%, distant relapse occurs in 25–40% of patients [2,3,4]. Neoadjuvant chemotherapy (NAC) without radiation for LARC has recently been explored to reduce distant relapse and avoid the toxicities of radiation without compromising local control [6,7,8]. A few randomized, controlled studies are ongoing, there is no literature comparing NACRT and NAC performed at a single institution where the surgical technique for LARC is relatively homogeneous [9,10,11]
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