Risk-Adapted Adjuvant Chemotherapy After Concomitant Fluoropyrimidine–Radiotherapy Neoadjuvant Treatment for Patients With Resectable CT3-4 or N+ Rectal Cancer: Five-Year Disease-Free Survival Results of a Single-Center Series

Sastre, Javier; Serrano, Javier; Fernández, Cristina; Ramı́rez, Carlos A.; Ortega, Luís; García-Paredes, Beatriz; Corona, J.; Alfonso, Rosario; Cordoba, Shaun-Paul; Dı́az-Rubio, Eduardo

doi:10.1016/j.clcc.2015.08.001

Cited by 3 publications

(1 citation statement)

References 26 publications

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“…Based on better 5-year survival rates for patients in our cohort treated with adjuvant ctx after neoadjuvant longterm ccrt and surgery at all postoperative T0-3 stages and even in the N0 stage, our findings emphasize the further benefit and feasibility of adjuvant ctx even in patients with a good response to preoperative ccrt [38][39][40][41] .…”

Section: Discussionmentioning

confidence: 99%

Pre- and Post-Surgery Treatments in Rectal Cancer: A Long-Term Single-Centre Experience

et al. 2017

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Section: Discussionmentioning

confidence: 99%

Pre- and Post-Surgery Treatments in Rectal Cancer: A Long-Term Single-Centre Experience

et al. 2017

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Controversies in the multimodality management of locally advanced rectal cancer

et al. 2017

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Neoadjuvant radiotherapy previous to radical surgery, both as short-course radiotherapy and as long-course radiotherapy combined with 5-FU-based chemotherapy (LCRCT), is routinely used in the management of locally advanced rectal cancer, with consistent benefits in the reduction in the local relapse risk. Unfortunately, survival benefits have been elusive to demonstrate with this approach, especially in the setting of radical surgery in the form of total mesorectal excision (TME). Concerns about over-treating early-stage patients and about the possible long-term side effects have also cast more doubts in a blanket approach of treating all patients with neoadjuvant radiotherapy, especially with LCRCT. In this review of selected controversial topics in locally advanced rectal cancer, we examine the benefits and drawbacks for the use of both neoadjuvant approaches in the TME era, the role of the intensification of the neoadjuvant regimens with new chemotherapy agents and modifications of the radiotherapy regimen, the usefulness of adjuvant chemotherapy, especially after LCRCT and surgery, and the management of elderly and/or frail patients. Finally, we offer some future perspectives in the management of these patients.

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Postoperative Adjuvant Treatment Strategy for Locally Advanced Rectal Cancer after Neoadjuvant Treatment

Huang

Gao

et al. 2021

BioMed Research International

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Background. Neoadjuvant (chemo) radiotherapy is used as a standard treatment for locally advanced rectal cancer (LARC), but there is no general consensus on either the efficacy of postoperative adjuvant chemotherapy in patients with LARC after neoadjuvant treatment and surgery, or whether the addition of oxaliplatin to adjuvant chemotherapy provides survival benefits. Methods. We performed a meta-analysis of data from the PubMed and Embase databases. We included patients with LARC who received neoadjuvant (chemo) radiotherapy and curative surgery. Overall survival (OS), disease-free survival (DFS), toxicity, and compliance were analyzed in the oxaliplatin/fluorouracil- (OX/FU-) based group compared with the FU-based group, and in the chemotherapy group compared with the observation group. Results. Twenty studies were included in the analysis. Our results indicated that adjuvant chemotherapy prolonged OS (hazard ratio HR = 0.78 , 95 % CI = 0.67 – 0.91 ) in patients with LARC treated with neoadjuvant (chemo) radiotherapy and surgery compared with those in the observation group. Subgroup analysis showed the same results in both the ypStage II and ypStage III groups. Compared with those in the observation group, patients in the chemotherapy group also showed an increase in DFS ( HR = 0.75 , 95 % CI = 0.60 – 0.93 ). No significant increase was observed in OS ( HR = 1.04 , 95 % CI = 0.87 – 1.24 ) or DFS ( HR = 0.98 , 95 % CI = 0.76 – 1.27 ) when oxaliplatin was added to FU-based adjuvant chemotherapy, as compared with the FU-based treatment, and subgroup analysis also indicated no survival benefits in the clinical stage II, clinical stage III, ypStage II, and ypStage III groups. Conclusions. For patients with LARC who have already received neoadjuvant (chemo) radiotherapy and curative surgery, adjuvant chemotherapy improves OS over that in the observation group. Adding oxaliplatin to FU-based adjuvant chemotherapy does not confer survival benefits beyond those from FU-based adjuvant chemotherapy.

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Risk-Adapted Adjuvant Chemotherapy After Concomitant Fluoropyrimidine–Radiotherapy Neoadjuvant Treatment for Patients With Resectable CT3-4 or N+ Rectal Cancer: Five-Year Disease-Free Survival Results of a Single-Center Series

Cited by 3 publications

References 26 publications

Pre- and Post-Surgery Treatments in Rectal Cancer: A Long-Term Single-Centre Experience

Pre- and Post-Surgery Treatments in Rectal Cancer: A Long-Term Single-Centre Experience

Controversies in the multimodality management of locally advanced rectal cancer

Postoperative Adjuvant Treatment Strategy for Locally Advanced Rectal Cancer after Neoadjuvant Treatment

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