scholarly journals Adjuvant chemotherapy may improve disease-free survival in patients with rectal cancer positive for MRI-detected extramural venous invasion following chemoradiation

2017 ◽  
Vol 19 (6) ◽  
pp. 537-543 ◽  
Author(s):  
M. Chand ◽  
S. Rasheed ◽  
R. Heald ◽  
I. Swift ◽  
N. West ◽  
...  
Keyword(s):  
Rectal Cancer ◽  
Adjuvant Chemotherapy ◽  
Disease Free Survival ◽  
Venous Invasion ◽  
Free Survival ◽  
Disease Free

Evaluation of response after chemoradiation for rectal cancer as a predictive factor for the benefit of adjuvant chemotherapy: A pooled analysis of 2,724 individual patients.

2011 ◽  
Vol 29 (4_suppl) ◽  
pp. 361-361 ◽  
Author(s):  
G. L. Beets ◽  
M. Maas ◽  
P. J. Nelemans ◽  
V. Valentini ◽  
C. H. Crane ◽  
...  
Keyword(s):  
Rectal Cancer ◽  
Adjuvant Chemotherapy ◽  
Individual Patient Data ◽  
Pathologic Complete Response ◽  
Disease Free Survival ◽  
Patient Data ◽  
Cox Proportional Hazards Model ◽  
Poor Responders ◽  
Free Survival ◽  
Disease Free

361 Background: Neoadjuvant chemoradiation (CRT) for rectal cancer increasingly results in pathologic response. It has been suggested that patients with different degrees of response might not have the same benefit of adjuvant chemotherapy. The aim was to determine whether patients with a pathologic complete response (pCR), ypT1-2 or ypT3-4 tumor after CRT for rectal cancer have different benefits of adjuvant chemotherapy for disease-free survival. Methods: Authors from studies evaluating different degrees of response to CRT were contacted to share individual patient data. The collected individual patient data were pooled into one dataset. To evaluate the effect of adjuvant chemotherapy on disease-free survival multivariate analyses according to the Cox proportional hazards model were performed. Hazard ratios (HR) with 95% confidence intervals (CI) were calculated for 3 subgroups: patients with pCR(ypT0N0), ypT1-2 tumor and ypT3-4 tumor after CRT. To determine benefit of adjuvant chemo for different pathologic N-stages we performed subgroup analyses. Results: 2,724 patients were included. 811 had pCR (28%), 863 had ypT1-2 (30%) and 1050 had ypT3-4 (37%). Median follow-up was 50 months (range 0-277). 41% underwent adjuvant chemotherapy, which consisted mostly of 5-FU based chemotherapy. The HR with 95%CI for disease-free survival for adjuvant chemotherapy was 0.94 (0.50-1.78) for patients with pCR, 0.61 (0.40-0.92) for patients with ypT1-2 tumors and 0.97 (0.75-1.25) for patients with ypT3-4 tumors. ypT1-2N0 patients benefited most from adjuvant chemo: HR 0.45 (0.27-0.75) vs. 0.79 (0.31-1.95) for patients with ypT1-2N+. For ypT3-4 patients pN-stage did not alter benefit of adjuvant chemo. Conclusions: Patients with pCR or ypT3-4 residual tumor after CRT do not seem to benefit from adjuvant chemo. This might be due to the already good prognosis of patients with pCR and less responsiveness to 5-FU based chemotherapy in the poor responders (the ypT3-4 tumors). Possibly adjuvant chemotherapy can be omitted or adapted for these patients. Patients with ypT1-2N0 benefit most from adjuvant chemo. No significant financial relationships to disclose.

scholarly journals Systematic Review: Adjuvant Chemotherapy for Locally Advanced Rectal Cancer with respect to Stage of Disease

2015 ◽  
Vol 2015 ◽  
pp. 1-10
Author(s):  
Shahab Hajibandeh ◽  
Shahin Hajibandeh
Keyword(s):  
Rectal Cancer ◽  
Adjuvant Chemotherapy ◽  
Locally Advanced ◽  
Disease Free Survival ◽  
Advanced Rectal Cancer ◽  
Locally Advanced Rectal Cancer ◽  
Stage Ii ◽  
Stage Iii ◽  
Free Survival ◽  
Disease Free

Background. Recent meta-analysis of 21 randomised controlled trials (RCTs) supports the use of adjuvant chemotherapy for nonmetastatic rectal carcinoma. In order to define a subgroup of patients who can potentially benefit from postoperative adjuvant chemotherapy, this study aims to review trials investigating adjuvant chemotherapy with respect to stage of disease in patients with locally advanced rectal cancer who had undergone surgery for cure (stage II and stage III). Methods. We searched electronic information sources to identify randomised trials evaluating adjuvant chemotherapy in patients with stages II and III rectal cancer with overall survival or disease-free survival as outcomes. Scottish Intercollegiate Guidelines Network notes on methodology were used to assess the methodological quality of the selected studies. Random-effects models were applied to calculate pooled outcome data. Results. Eight studies reporting total of 5527 patients were selected for analysis. Adjuvant chemotherapy was associated with statistically significant improvement in disease-free survival and overall survival compared to surgery alone in both stage II and stage III cancer. Conclusions. This study indicates that both stage II and stage III rectal cancer patients may benefit from postoperative adjuvant chemotherapy. However, the benefits of adjuvant chemotherapy for patients who already had neoadjuvant chemoradiation still remain unknown.

MRI-defined high-risk rectal cancer patients: outcome comparison between neoadjuvant chemoradiotherapy plus TME and TME plus adjuvant chemotherapy or TME alone

2021 ◽  
Vol 94 (1120) ◽  
pp. 20201221
Author(s):  
Xiaoxuan Jia ◽  
Peiyi Xie ◽  
Liang Bi ◽  
Xiaochun Meng ◽  
Ziqiang Wang ◽  
...  
Keyword(s):  
Rectal Cancer ◽  
High Risk ◽  
Adjuvant Chemotherapy ◽  
Neoadjuvant Chemoradiotherapy ◽  
Disease Free Survival ◽  
Venous Invasion ◽  
Tumor Stage ◽  
Free Survival ◽  
Kaplan Meier ◽  
Outcome Comparison

Objective: The goal of this study was to investigate whether neoadjuvant chemoradiotherapy (NCRT) plus total mesorectal excision (TME) would improve the outcome of patients with MRI-defined high-risk rectal cancer compared with TME plus adjuvant chemotherapy (ACT) or TME alone. Methods: We retrospectively enrolled 362 patients with MRI-defined high-risk rectal cancer who were treated with NCRT plus TME, TME plus ACT, or TME alone between January 2008 and August 2018. Cases with a high-risk tumor stage, positive extramural venous invasion, or mesorectal fascia involvement on baseline MRI were considered cases of high-risk rectal cancer. We matched patients treated with NCRT plus TME to patients treated with TME plus ACT and to those treated with TME alone. Kaplan–Meier curves were used to compare local recurrence (LR), disease-free survival (DFS), and overall survival (OS) rates. Results: The cumulative 3 year LR rate in the matched NCRT plus TME group was more favorable than in the TME plus ACT group (0% vs 5.1%; p = 0.037; n = 98) and in the TME alone group (0% vs 11.5%; p = 0.016; n = 61). Patients who received NCRT plus TME demonstrated better cumulative 3 year DFS rates than patients treated with TME plus ACT (85.7% vs 65.3%; p = 0.009) or with TME alone (86.9% vs 68.9%; p = 0.046). No difference in OS was observed among the groups. Conclusion: NCRT may improve DFS and LR rates in patients with MRI-defined high-risk rectal cancer when compared with TME plus ACT or TME alone. Advances in knowledge: This study illustrated the specific benefit of NCRT on the outcome measures of MRI-defined high-risk rectal cancer compared with TME plus ACT or TME alone, which was not clearly clarified in previous studies enrolling all patients with Stage II/III rectal cancer.

Tumor Diameter Is an Easy and Useful Predictor of Recurrence in Stage II Colorectal Cancer

2015 ◽  
Vol 32 (5) ◽  
pp. 338-343 ◽  
Author(s):  
Chiyo Maeda ◽  
Eiji Hidaka ◽  
Yuichi Mori ◽  
Shumpei Mukai ◽  
Hideyuki Miyachi ◽  
...  
Keyword(s):  
Colorectal Cancer ◽  
Rectal Cancer ◽  
Multivariate Analysis ◽  
Adjuvant Chemotherapy ◽  
Disease Free Survival ◽  
Venous Invasion ◽  
Stage Ii ◽  
Tumor Diameter ◽  
Free Survival ◽  
Stage Ii Colorectal Cancer

Background/Aims: Adjuvant chemotherapy for stage II colorectal cancer (CRC) can generally be administered to high-risk subgroups. To better identify these patients, we aimed at assessing factors that affect recurrence. Methods: In our hospital, 432 colon and 96 rectal stage II cancer patients who underwent surgical resection between 2001 and 2011 were divided into recurrence and non-recurrence groups. Age, sex, lymphatic vessel invasion, venous invasion, tumor diameter, tumor depth, histological type, preoperative carcinoembryonic antigen level, number of sampled nodes, adjuvant chemotherapy, morphology, surgical approach, anastomotic leakage, preoperative bowel obstruction, and preoperative perforation were retrospectively compared between the groups. Results: For colon cancer, multivariate analysis revealed a significant association between tumor diameter ≥40 mm and recurrence (p = 0.039). For rectal cancer, multivariate analysis revealed that tumor diameter ≥50 mm (p = 0.001) and ≤12 sampled nodes (p = 0.021) were associated with recurrence. Tumor diameter in rectal cancer was associated with worse disease-free survival (p = 0.026). Conclusion: Tumor diameter is a significant predictor of recurrence in stage II CRC. This is an important finding because tumor diameter is easy to evaluate clinically and might help to identify candidates for adjuvant chemotherapy.

Preoperative chemoradiotherapy and postoperative chemotherapy with 5-fluorouracil and oxaliplatin versus 5-fluorouracil alone in locally advanced rectal cancer: First results of the German CAO/ARO/AIO-04 randomized phase III trial.

2011 ◽  
Vol 29 (18_suppl) ◽  
pp. LBA3505-LBA3505 ◽  
Author(s):  
C. Roedel ◽  
H. Becker ◽  
R. Fietkau ◽  
U. Graeven ◽  
W. Hohenberger ◽  
...  
Keyword(s):  
Rectal Cancer ◽  
Adjuvant Chemotherapy ◽  
Primary Endpoint ◽  
Locally Advanced ◽  
Disease Free Survival ◽  
Advanced Rectal Cancer ◽  
Preoperative Chemoradiotherapy ◽  
Locally Advanced Rectal Cancer ◽  
Free Survival ◽  
Disease Free

LBA3505 Background: The German CAO/ARO/AIO-94 trial established preoperative chemoradiotherapy (CRT), surgery, and postoperative chemotherapy with 5-FU as standard treatment for locally advanced rectal cancer. With this approach local relapse rates are below 10%. The development of distant metastasis is the predominant mode of failure. Integrating more effective systemic treatment into combined modality therapy was the goal of CAO/ARO/AIO-04. Methods: Between 7/2006-2/2010, patients with rectal cancer within 12 cm from the anal verge and clinical evidence of perirectal fat or lymph node involvement were randomly assigned to receive preoperative CRT, surgery, and adjuvant chemotherapy with 5-FU according to CAO/ARO/AIO-94 (arm 1), or preoperative CRT (50.4 Gy in 28 fractions) with 5-FU (250 mg/m2/days 1-14 and 22-35) and oxaliplatin (50 mg/m2/days 1, 8, 22, 29), surgery, and 8 cycles of adjuvant chemotherapy according to modified FOLFOX6 regimen (arm 2). Disease-free survival was the primary endpoint. We present early secondary endpoints, including acute toxicity, treatment compliance, and pCR-rates. Results: 637 patients were randomly assigned to arm 1 and 628 to arm 2. Full dose preoperative RT and full dose concurrent chemotherapy was delivered in 97% and 74% of patients in both arms, respectively. Preoperative grade 3/4 toxicity occurred in 21.6% in arm 1 and in 22.9% in arm 2. The R0-resection rate was 95.4% in both arms, and abdominoperineal resections were limited to 11.9% and 12.2% in arms 1 and 2, respectively. Overall postoperative complications were not different between both arms (21.0% and 21.9%). The pCR rate (ypT0N0) was 13.1% in arm 1 and 17.6% in arm 2 (p = 0.033, Cochran-Mantel-Haenszel Chi-Squared Test without continuity correction for conditional independence of pCR rate in the two treatment arms in each stratum). Conclusions: Inclusion of oxaliplatin to 5-FU based CRT was well tolerated and associated with increased pCR-rates compared with 5-FU-CRT alone. Longer follow-up is necessary to evaluate the primary endpoint, disease-free survival.

Impact on overall survival and disease-free survival of adjuvant chemotherapy after neoadjuvant chemoradiotherapy for rectal cancer.

2012 ◽  
Vol 30 (15_suppl) ◽  
pp. e14173-e14173
Author(s):  
Rafael amaral de Castro ◽  
Carlos Eduardo Paiva ◽  
Rogerio Saad-Hossne ◽  
Odair Carlito Michelin ◽  
Cristiano de padua Souza
Keyword(s):  
Rectal Cancer ◽  
Overall Survival ◽  
Adjuvant Chemotherapy ◽  
Adjuvant Treatment ◽  
Neoadjuvant Chemoradiotherapy ◽  
Disease Free Survival ◽  
Free Survival ◽  
Group 2 ◽  
Disease Free ◽  
Group 1

e14173 Background: Colorectal cancer is the second most common cancer with 2,4 million people diagnosed. The rectal cancer (RC) is 27% of these cases. Neoadjuvant chemoradiotherapy (NCRT) has become standard but brought controversy in the adjuvant treatment. The objective was to assess the impact of adjuvant chemotherapy after NCRT. Methods: Between mar/96 and Oct/2010, 84 patients received NCRT, and 58 patients underwent resection of the rectum. The NCRT consisted of 5-FU 350mg/m2, D1-D5 (50% of cases) or 5-FU 425mg/m2, D1-D3 (43%) with LV 20mg/m2 bolus in the 1st and 5th week of the 25 sessions of radiotherapy in linear accelerator (total 45 - 50 Gy). When performed, Adjuvant chemotherapy (ADJC) consisted of 5-FU 425mg/m2, LV 20mg/m2, both on D1-D5 for 4 cycles. Evaluation of Overall Survival (O.S) and Disease-Free Survival (DFS) performed using Kaplan-Meier curve in SPSS version 13.0 Results: Of the 58 patients who underwent surgery, 90% were stage II, 51% occurred in the lower rectum and 66% were ECOG 1. Pathologic Complete Response (PCR) was obtained in 25.8% (15) of patients (group 1). Of these, 20% (3) received ADJC. Patients without PCR (group 2) received ADJC in 51% of the cases (22). The mean follow-up was 41 months. Both the DFS (HR: 2.594, 95% CI: 1134-5938, p = 0.024) and OS (HR: 2.615, 95% CI: 1005-6807, p = 0.0488) were higher in patients with PCR independent of the use of ADJC. On the other hand, patient treated with ADJC vs without ADJC, independent of presence of PCR, did not alter DFS (p = 0.74) or OS (p = 0.32). In PCR patients, ADJC do not interfere in the outcome (DFS, p = 0.76; SG, p = 0.73). In group 2 (patients without PCR), the subgroup with ADJC, there was a trend towards better SLD (p = 0.06) and OS (p = 0.06). Those who did not receive ADJC in group 2 had worse SLD (p = 0.011) and OS (p = 0.028) compared with group-1. Conclusions: Adjuvant treatment after NCRT did not increase OS or DFS. Patients without PRC had worse results without ADJC, compared to those with PCR. The first, probably, the subgroup of patients who benefited most from the use of ADJC. PCR improves OS and DFS regardless of ADJC, being perhaps the group that does not deserve ADJC.

scholarly journals To Explore the Effect of NLR and PLR on Prognosis of Rectal Cancer on the basis of T3 substage, and to draw the related nomogram

2021 ◽  
Author(s):  
Donglin Li ◽  
Shuang Wang ◽  
Yongping Yang ◽  
Zeyun Zhao ◽  
An Shang ◽  
...  
Keyword(s):  
Risk Factors ◽  
Rectal Cancer ◽  
Adjuvant Chemotherapy ◽  
Area Under The Curve ◽  
Disease Free Survival ◽  
Postoperative Adjuvant Chemotherapy ◽  
Free Survival ◽  
N Stage ◽  
Independent Risk Factors ◽  
Disease Free

Abstract Background: Approximately 50% of patients with rectal cancer are classified into T3 stage, and they are positioned as substage by various criteria. These patients with different neutrophil-to-lymphocyte ratio (NLR) and platelet-to-lymphocyte ratio (PLR) develop disparate outcomes. We sought to develop and validate nomograms to predict survival in patients with rectal cancer on the basis of T3 substage.Methods: We conducted a retrospective cohort study by collecting 170 cases from China. Individuals with rectal cancer after 2 or more years of follow up after surgery were eligible for inclusion. Candidate predictors consisted of NLR, PLR, T3 substage and clinical characteristics available at the time of rectal cancer diagnosis. The optimal cut-off values for NLR and PLR were determined using X-Tile (Version 3.6.1) software and were determined before statistical analyses. Variables with P values below 0.1 in the univariable analyses were further evaluated using Cox multivariate analysis. Model discrimination was assessed using receiver operating characteristic (ROC) curve and concordance index (C-index) analysis. Results were internally validated using related software.Results: We analyzed data from 170 patients with T3 rectal cancer. The optimal cut-off value of NLR in relation to overall and disease-free survival were 3.1 and 2.9, and that of PLR were 181.9 and 202.7. Among them, postoperative adjuvant chemotherapy, T3 substage, N stage, CA199 and NLR were independent risk factors affecting overall survival（OS）and disease-free survival (DFS). There was no significant difference in survival rate between T3a and T3b, or between T3c and T3d. The final nomograms of 2-year OS (area under the curve,0.886; The c-index,0.870) and 2-year DFS (area under the curve,0.895; The c-index,0.867) were developed according to independent risk factors analyzed by SPSS 26 (SPSS Inc., Chicago, IL, USA) software. The calibration curves showed negligible optimism.Conclusion: We developed nomograms based on postoperative adjuvant chemotherapy, T3 substage, N stage, CA199 and NLR to help identify patients with poor prognosis and to guide individualized therapy.

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