Pilot study of modified FOLFOX6 adjuvant chemotherapy for high-risk rectal cancer treated with neoadjuvant chemoradiotherapy

2015 ◽  
Vol 76 (1) ◽  
pp. 29-34
Author(s):  
Soo Jung Lee ◽  
Byung Woog Kang ◽  
Yee Soo Chae ◽  
Seung Hyun Cho ◽  
Hye Jin Kim ◽  
...  
Keyword(s):  
Rectal Cancer ◽  
Pilot Study ◽  
High Risk ◽  
Adjuvant Chemotherapy ◽  
Neoadjuvant Chemoradiotherapy ◽  
Modified Folfox6

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.

Delays in adjuvant chemotherapy following AP resection for low rectal cancer: Audit results and implications for clinical practice.

2011 ◽  
Vol 29 (4_suppl) ◽  
pp. 562-562
Author(s):  
S. S. Nimalasena ◽  
A. M. Gaya
Keyword(s):  
Rectal Cancer ◽  
Adjuvant Chemotherapy ◽  
Neoadjuvant Chemotherapy ◽  
Locally Advanced ◽  
Significant Proportion ◽  
Neoadjuvant Chemoradiotherapy ◽  
Wound Dehiscence ◽  
Low Rectal Cancer ◽  
Wound Complications ◽  
Phase Ii Studies

562 Background: Abdominoperineal resection (APR) remains the surgical procedure of choice for low rectal cancer. Historically, it has been associated with high rates of postoperative haemorrhage, infection, and wound dehiscence. The perineal wound is particularly at risk, with rates of 16-41% reported. This may delay adjuvant chemotherapy and adversely affect survival. Methods: Patients who underwent APR in our cancer network between March 2009 and June 2010 were identified. Records were reviewed with respect to complications and any impact on adjuvant chemotherapy. Results: 28 patients underwent APR. The majority had Duke's C (68%) and Duke's B (14%) tumors. All received neoadjuvant chemoradiotherapy (CRT) to 45-54Gy with capecitabine 825 mg/m2 BD. Adjuvant chemotherapy (CAPOX, FOLFOX or capecitabine) was planned in 25/28 (89%) patients. 2 declined, and of the remaining 23, 12 patients (52%) could not receive chemotherapy (Table). Of patients who received adjuvant chemotherapy, the average delay in starting was 2 weeks. At the time of reporting, 25/28 (86%) patients are alive without disease recurrence. One patient who did not receive adjuvant chemotherapy due to wound dehiscence, has recurrent pelvic disease, and is receiving best supportive care. Two patients died of metastatic disease; one could not receive adjuvant chemotherapy due to wound infection. Conclusions: Our audit has highlighted that a significant proportion of patients undergoing APR do not receive adjuvant chemotherapy on time due to wound complications. Often the time taken for wound healing exceeds 3 months, by which time the benefit of chemotherapy is negligible. Phase II studies of neoadjuvant chemotherapy prior to CRT for locally advanced rectal cancer have shown impressive progression-free and overall survival rates, with good compliance rates and favorable toxicity profiles. Further studies are needed. Patients with low rectal tumours who require APR, should be considered for a neoadjuvant chemotherapy approach. [Table: see text] No significant financial relationships to disclose.

What determines adjuvant chemotherapy use after neoadjuvant chemoradiotherapy for rectal cancer?

2012 ◽  
Vol 30 (4_suppl) ◽  
pp. 546-546 ◽  
Author(s):  
George J. Chang ◽  
Chung-Yuan Hu ◽  
Y. Nancy You ◽  
Cathy Eng ◽  
Miguel A. Rodriguez-Bigas ◽  
...  
Keyword(s):  
Rectal Cancer ◽  
Adjuvant Chemotherapy ◽  
Treatment Guidelines ◽  
Locally Advanced ◽  
Neoadjuvant Chemoradiotherapy ◽  
Radical Resection ◽  
Advanced Rectal Cancer ◽  
Locally Advanced Rectal Cancer ◽  
Clinicopathologic Characteristics ◽  
Treatment Standard

546 Background: The treatment standard for rectal cancer patients after neoadjuvant chemoradiotherapy (CXRT) and radical resection includes adjuvant chemotherapy (CT). The purpose of this study was to evaluate patient demographic and clinicopathologic characteristics in relation to adjuvant CT use. Methods: A retrospective cohort study of patients ≥ 65 years old with rectal cancer treated by neoadjuvant CXRT and radical resection in the Surveillance, Epidemiology, and End Results-linked Medicare database (1998-2007, Medicare Part A/B only) was performed. Multivariate logistic regression was used to assess CT utilization in relation to patient, tumor and treatment response characteristics. Results: Among 1344 patients who met study criteria, 748 (55.6%) received adjuvant CT with 5-fluorouracil (FU) including 189 (25.3%) who also received oxaliplatin (Ox). ypStage was the strongest determinant of both any post-operative CT (43.1% stage I, 51.3% stage II, 73.4% stage III). Other associated factors included age, comorbidity, marital status and surgery type. In addition, age, socioeconomic status, and grade were associated with Ox use. These effects persisted even after exclusion of patients with comorbidities. Conclusions: Although standard treatment guidelines for locally advanced rectal cancer include postoperative CT for all patients after neoadjuvant CXRT and radical resection, nearly 1 in 2 patients failed to receive adjuvant CT. Despite the absence of established evidence, treatment decisions appear to be influenced by the findings at surgical pathology. [Table: see text]

INNOVA: A phase II randomized study comparing INterval versus NeOadjuVAnt chemotherapy in magnetic resonance imaging-defined high risk rectal cancer.

2018 ◽  
Vol 36 (4_suppl) ◽  
pp. TPS879-TPS879
Author(s):  
Ramakrishnan Ayloor Seshadri ◽  
Trivadi S. Ganesan ◽  
Arunkumar M N ◽  
Shirley Sundersingh
Keyword(s):  
Rectal Cancer ◽  
High Risk ◽  
Adjuvant Chemotherapy ◽  
Neoadjuvant Chemotherapy ◽  
Phase Ii ◽  
Pathological Complete Response ◽  
Locally Advanced ◽  
Complete Response ◽  
Neoadjuvant Chemoradiation ◽  
Rectal Cancers

TPS879 Background: Patients with rectal cancers treated with neoadjuvant chemoradiation followed by surgery and adjuvant chemotherapy are not exposed to systemic doses of chemotherapy until very late in the treatment schedule. Preoperative chemotherapy, either in the neoadjuvant or interval setting can lead to early treatment of micrometastasis, improve the tumor response and possibly the overall survival. Phase II studies of neoadjuvant chemotherapy in rectal cancer have shown good response to chemotherapy with no tumor progression and good compliance. A phase II study evaluating the effect of giving chemotherapy in the interval waiting period between chemoradiation and surgery has shown acceptable toxicity and high pathological complete response rates. Methods: This single centre, randomized, open label, phase II trial compares the safety and efficacy of two pre-operative regimens in locally advanced MRI defined high-risk rectal cancers. Based on the Simon optimal two-stage design, 94 patients will be randomised to either Arm A [3 cycles of neoadjuvant chemotherapy (capecitabine and oxaliplatin) followed by chemoradiation (50.4 Gy with capecitabine) and then surgery] or Arm B [neoadjuvant chemoradiation followed by 3 cycles of interval chemotherapy and then surgery]. Patients in both arms receive 3 cycles of adjuvant chemotherapy. The primary end-point is the pathological complete response rate. Secondary end-points include frequency and severity of adverse events, RO resection rates, tumor regression grading and compliance to treatment. The inclusion criteria: age 18 to 70 years; ECOG performance status 0-2; non-metastatic, locally advanced rectal cancer with any one of the following features on high-resolution thin slice MRI: any T3/T4 tumor in the lower rectum, T3c/T3d/T4 tumor in the mid rectum, N2 disease, threatened mesorectal fascia, or extramural vascular invasion. Patients are randomly assigned to one of the two intervention arms in a 1:1 ratio. Prespecified activity goal for the first stage of accrual was met; second stage accrual began in July 2017. Clinical trial information: CTRI/2015/01/005385.

scholarly journals Is adjuvant chemotherapy necessary for patients with ypT0–2N0 rectal cancer treated with neoadjuvant chemoradiotherapy and curative surgery?

2018 ◽  
Vol 6 (4) ◽  
pp. 277-283 ◽  
Author(s):  
Zhao Lu ◽  
Pu Cheng ◽  
Ming-Guang Zhang ◽  
Xi-Shan Wang ◽  
Zhao-Xu Zheng
Keyword(s):  
Rectal Cancer ◽  
Adjuvant Chemotherapy ◽  
Neoadjuvant Chemoradiotherapy ◽  
Curative Surgery

Are pathological high-risk features in locally advanced rectal cancer a useful selection tool for adjuvant chemotherapy?

2018 ◽  
Vol 89 ◽  
pp. 1-8 ◽  
Author(s):  
Marloes Swets ◽  
Peter J.K. Kuppen ◽  
Erik J. Blok ◽  
Hans Gelderblom ◽  
Cornelis J.H. van de Velde ◽  
...  
Keyword(s):  
Rectal Cancer ◽  
High Risk ◽  
Adjuvant Chemotherapy ◽  
Locally Advanced ◽  
Advanced Rectal Cancer ◽  
Locally Advanced Rectal Cancer ◽  
Selection Tool
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