Comparing outcomes following total neoadjuvant therapy and following neoadjuvant chemoradiation therapy in patients with locally advanced rectal cancer

Zhu, Shaoyu; Brodin, N. Patrik; English, Keara; Ohri, Nitin; Chuy, Jennifer; Rajdev, Lakshmi; Narang, Rahul; Guha, Chandan; Garg, Madhur; Kabarriti, Rafi

doi:10.1016/j.eclinm.2019.09.009

Cited by 20 publications

(22 citation statements)

References 16 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…No statistically significant difference was observed in five-year OS between treatment groups (TNT 76.2% vs. nCRT 69.9%), despite higher utilization of TNT for more advanced-stage disease. This is consistent with other NCDB analyses demonstrating no difference in overall survival between treatment groups [13,14]. However, when stratified by clinical stage, we found that patients with cT3 or cN1 disease had better OS when treated with TNT versus nCRT.…”

Section: Discussionsupporting

confidence: 92%

Predictors of Pathologic Response After Total Neoadjuvant Therapy in Patients With Rectal Adenocarcinoma: A National Cancer Database Analysis

McDermott¹,

Singh²,

Renz³

et al. 2021

Cureus

View full text Add to dashboard Cite

Purpose/objectivesInduction chemotherapy followed by chemoradiation and surgical resection in rectal cancer, known as total neoadjuvant therapy (TNT), is associated with improved pathologic complete response (pCR) rates. The National Cancer Database was utilized to identify factors associated with pCR and survival following treatment with TNT compared to standard neoadjuvant chemoradiation (nCRT). Materials/methodsThe National Cancer Database was queried from 2004 to 2015 for patients with locally advanced, nonmetastatic rectal cancer. We identified 16,299 patients receiving neoadjuvant chemotherapy and radiation followed by definitive surgical resection. Patients were stratified by treatment received, either TNT (n=350) or nCRT (n=15,949). Multivariate binomial regression analysis and propensity matching were used to evaluate predictors of pCR. Kaplan-Meier and Cox multivariate analysis of survival were performed. ResultsMedian follow-up was 38 months vs 53 months in the TNT vs nCRT groups, respectively. There were more patients with T4 or node-positive disease in the TNT group. There was a trend towards improved pCR in the TNT group (p=0.053). Patients achieving pCR had improved 5-year overall survival (OS) of 85.1%. The 5-year OS was not improved for TNT (76.2%) over nCRT (69.9%) (p=0.19). Pelvic nodal pCR was significantly higher in the TNT group (72%). When stratified by clinical stage, patients with cT3 (p=0.038) or cN1 (p=0.049) disease had improved OS with TNT. ConclusionsCompared to nCRT, TNT is correlated with higher rates of complete pelvic nodal clearance in patients with locally advanced rectal adenocarcinoma. The use of TNT showed improved survival in patients with cT3 and cN1 disease, indicating a potential benefit for patients with less advanced disease.

show abstract

Section: Discussionsupporting

confidence: 92%

Predictors of Pathologic Response After Total Neoadjuvant Therapy in Patients With Rectal Adenocarcinoma: A National Cancer Database Analysis

McDermott¹,

Singh²,

Renz³

et al. 2021

Cureus

View full text Add to dashboard Cite

show abstract

“… 27 – 29 The NCDB does not delineate TNT in the database, and using the definition as described by Zhu et al, our study contains only 49 (2.0%) patients that may have undergone TNT. 13 Due to the low percentage and need for a surrogate definition, these patients were not removed from the cohort.…”

Section: Discussionmentioning

confidence: 99%

“… 11 , 12 TNT was defined as any patient that received radiotherapy and multi-agent chemotherapy prior to oncologic resection, RT was started a minimum of 2 months after chemotherapy, and no adjuvant chemotherapy was given. 13 Cancer-specific and treatment-specific variables were also collected. Hospital volume was determined by calculating the total number of surgical cases in the rectum NCDB PUF for each facility.…”

Section: Methodsmentioning

confidence: 99%

Omission of Adjuvant Chemotherapy in Rectal Cancer Patients with Pathologic Complete Response: a National Analysis

Morris

Winer

Lee

et al. 2021

Journal of Gastrointestinal Surgery

View full text Add to dashboard Cite

Background An increasing number of patients achieve a pathologic complete response (pCR) after neoadjuvant chemoradiation for locally advanced rectal cancer. Consensus guidelines continue to recommend oncologic resection followed by adjuvant chemotherapy in these patients. We hypothesize that there is significant variability in compliance with this recommendation. Methods The National Cancer Database was queried from 2006 to 2015 for patients with locally advanced rectal cancer who underwent neoadjuvant chemoradiation followed by oncologic resection with a pCR (ypT0N0). Hierarchical logistic regression models were used to generate risk and reliability-adjusted rates of adjuvant chemotherapy utilization in patients with pCR at each hospital. Results In total, 2421 pCR patients were identified. Five-year overall survival was improved in pCR patients who received adjuvant chemotherapy compared with those who did not (92 vs. 85%, p < 0.01). Multivariate analysis indicated that improvement in overall survival remained associated with adjuvant chemotherapy (HR 0.60, 95% CI 0.44-0.82, p < 0.01). The mean adjuvant chemotherapy utilization rate among hospitals was 32%. There was an upward trend in use over the past decade, but two-thirds still do not receive the recommended therapy. High chemotherapy utilizer hospitals were more likely to be academic centers (54.9 vs. 45.9%, p < 0.01) when compared with low chemotherapy utilizers. Conclusion Adjuvant chemotherapy is associated with improved survival in rectal cancer patients with pCR following neoadjuvant chemoradiation and oncologic resection. However, utilization among centers in the USA was only 32% with significant variability across centers. National efforts are needed to standardize treatment patterns according to national guidelines.

show abstract

“…TNT is an emerging systemic treatment regimen that incorporates combination chemotherapy into the neoadjuvant therapy 26–28 . It aims to improve rates of pathological complete response and reduce the risk of distant failure, which is the ultimate determinant of OS 28,29 .…”

Section: Discussionmentioning

confidence: 99%

Positive lateral pelvic lymph nodes in low rectal cancer: should we change our practice now?

Gartrell

Hong

Baker

et al. 2021

ANZ Journal of Surgery

View full text Add to dashboard Cite

Background The role of lateral lymph node dissection (LLND) in the treatment of patients with low rectal cancer with enlarged lateral lymph nodes (LLN+) is under investigation. Enthusiasm for LLND stems from a perceived reduction in local recurrence (LR). We aimed to compare the LR rate for LLN+ patients with LLN− patients, treated with neoadjuvant chemoradiotherapy (nCRT) and surgery, in a hospital that does not perform LLND. Methods A retrospective study of all patients with clinical stage 3 low rectal cancer who completed nCRT and surgery between 2008 and 2017 at Western Health was performed. Outcomes for LLN+ patients were compared with LLN− patients. The primary outcome was LR. Secondary outcomes included distant metastases, disease‐free survival and overall survival. Results There were 110 patients treated for stage 3 low rectal cancer over 10 years. There was no significant difference in the LR rate, with one LR from 28 LLN+ patients and one LR from 82 LLN− patients (4% versus 1.2%, P = 0.44). There were no significant differences in median disease‐free survival (41 versus 52 months, P = 0.19) or mean overall survival (62 versus 60 months, P = 0.80). Of all patients studied, 21% developed distant metastases. Conclusion LR after nCRT and surgery in patients with stage 3 rectal cancer is rare, irrespective of lateral pelvic node status. These data, along with the uncertain benefit and known risks of LLND, supports the continued use of standard therapy in these patients. Strategies to address distant failure in these patients should be explored.

show abstract

Comparing outcomes following total neoadjuvant therapy and following neoadjuvant chemoradiation therapy in patients with locally advanced rectal cancer

Cited by 20 publications

References 16 publications

Predictors of Pathologic Response After Total Neoadjuvant Therapy in Patients With Rectal Adenocarcinoma: A National Cancer Database Analysis

Predictors of Pathologic Response After Total Neoadjuvant Therapy in Patients With Rectal Adenocarcinoma: A National Cancer Database Analysis

Omission of Adjuvant Chemotherapy in Rectal Cancer Patients with Pathologic Complete Response: a National Analysis

Positive lateral pelvic lymph nodes in low rectal cancer: should we change our practice now?

Contact Info

Product

Resources

About