We found a match
Your institution may have access to this item. Find your institution then sign in to continue.
- Title
Survival After Induction Chemotherapy and Chemoradiation Versus Chemoradiation and Adjuvant Chemotherapy for Locally Advanced Rectal Cancer.
- Authors
Kim, Jin K; Marco, Michael R; Roxburgh, Campbell S D; Chen, Chin-Tung; Cercek, Andrea; Strombom, Paul; Temple, Larissa K F; Nash, Garrett M; Guillem, Jose G; Paty, Philip B; Yaeger, Rona; Stadler, Zsofia K; Gonen, Mithat; Segal, Neil H; Reidy, Diane L; Varghese, Anna; Shia, Jinru; Vakiani, Efsevia; Wu, Abraham J; Romesser, Paul B
- Abstract
Background Total neoadjuvant therapy (TNT) improves tumor response in locally advanced rectal cancer (LARC) patients compared to neoadjuvant chemoradiotherapy alone. The effect of TNT on patient survival has not been fully investigated. Materials and Methods This was a retrospective case series of patients with LARC at a comprehensive cancer center. Three hundred and eleven patients received chemoradiotherapy (chemoRT) as the sole neoadjuvant treatment and planned adjuvant chemotherapy, and 313 received TNT (induction fluorouracil and oxaliplatin-based chemotherapy followed by chemoradiotherapy in the neoadjuvant setting). These patients then underwent total mesorectal excision or were entered in a watch-and-wait protocol. The proportion of patients with complete response (CR) after neoadjuvant therapy (defined as pathological CR or clinical CR sustained for 2 years) was compared by the χ 2 test. Disease-free survival (DFS), local recurrence-free survival, distant metastasis-free survival, and overall survival were assessed by Kaplan-Meier analysis and log-rank test. Cox regression models were used to further evaluate DFS. Results The rate of CR was 20% for chemoRT and 27% for TNT (P =.05). DFS, local recurrence-free survival, metastasis-free survival, and overall survival were no different. Disease-free survival was not associated with the type of neoadjuvant treatment (hazard ratio [HR] 1.3; 95% confidence interval [CI] 0.93-1.80; P =.12). Conclusions Although TNT does not prolong survival than neoadjuvant chemoradiotherapy plus intended postoperative chemotherapy, the higher response rate associated with TNT may create opportunities to preserve the rectum in more patients with LARC.
- Subjects
ADJUVANT chemotherapy; CONFIDENCE intervals; RECTUM tumors; CANCER chemotherapy; LOG-rank test; ANTINEOPLASTIC agents; RETROSPECTIVE studies; CANCER relapse; METASTASIS; CHEMORADIOTHERAPY; TREATMENT effectiveness; CANCER patients; FLUOROURACIL; DISEASE relapse; SURVIVAL analysis (Biometry); CHI-squared test; KAPLAN-Meier estimator; DESCRIPTIVE statistics; COMBINED modality therapy; OXALIPLATIN; PROGRESSION-free survival; PROPORTIONAL hazards models; EVALUATION
- Publication
Oncologist, 2022, Vol 27, Issue 5, p380
- ISSN
1083-7159
- Publication type
Article
- DOI
10.1093/oncolo/oyac025