Comparison of efficacy and safety of preoperative Chemoradiotherapy in locally advanced upper and middle/lower rectal cancer

Abstract

BackgroundWe aimed to explore the efficacy and safety profile of preoperative neoadjuvant chemoradiation (NACRT) in locally advanced rectal cancer (LARC) in upper rectum versus middle/lower rectum.MethodsThe study included 173 patients with stage II or III (T2-4b, N0-2b) LARC who underwent NACRT followed by total mesorectal excision (TME) between January 2011 and October 2016. Cox regression, log-rank test, and Kaplan–Meier curves were calculated.ResultsAmong the 173 patients, 58 had lesions in the upper rectum and 115 patients had lesions in middle/lower rectum. In a median follow-up of 35 months (range, 6–73 months), the 5-year disease-free survival (DFS) and overall survival (OS) were 84% and 88% for the patients with upper rectal cancer and 77% and 68% for those with middle/lower rectal cancer (P = 0.251 and P = 0.058, respectively). The 5-year DFS (P = 0.012) and OS (P = 0.003) were better in the NACRT responders [tumor regression grade (TRG) 0 or 1] compared with nonresponders (TRG 2 or 3). The independent prognostic factor of favorable response to NACRT was the FOLFOX regimen (P = 0.004).ConclusionsPatients with LARC in the upper rectum who underwent NACRT followed by TME had similar DFS and a trend toward longer OS, compared with those who had middle/lower rectal lesions. Furthermore, FOLFOX may yield superior results than fluoropyrimidine based regimen during NACRT. NACRT might be an alternative option for patients with LARC in the upper rectum as it has a favorable pathological complete response rate and comparable clinical outcomes when compared with patients with LARC in middle/lower rectum.

Predictive Value of FOLFOX-Based Regimen, Long Interval, Hemoglobin Levels and Clinical Negative Nodal Status, and Postchemoradiotherapy CEA Levels for Pathological Complete Response in Patients with Locally Advanced Rectal Cancer after Neoadjuvant Chemoradiotherapy

“…A fluoropyrimidine-based regimen was delivered to 95 patients. e regimen included (1) 5-fluorouracil (5-FU; 350 mg/m 2 , intravenous bolus) and leucovorin (20 mg/m 2 , intravenous bolus) on days 1 to 5 and days 21 to 25 of irradiation, once every 2 weeks or (2) 6 cycles of capecitabine 850 mg/m 2 twice daily for 14 days, followed by 7 days of rest after each cycle [19]. For the rest of the 141 patients, a biweekly schedule of FOLFOX was prescribed.…”

Surgical treatment following neoadjuvant chemoradiotherapy in locally advanced rectal cancer

“…The study revealed that after R0 resections for tumors in TNM stages I‐III, LR was noted in 10% of tumors at 0‐5 cm, in 8% at 6‐10 cm, and in 6% at 11‐15 cm above the anal verge; preoperative RT reduced the LR rate irrespective of height [0‐5 cm: OR 0.50 (0.30‐0.83), 6‐10 cm: OR 0.42 (0.25‐0.71), and 11‐15 cm: OR 0.29 (0.13‐0.64)], and the study suggested that preoperative RT should be considered in the upper rectum. In 2018, Huang et al presented a study and concluded that patients with LARC in the upper rectum and receiving NCRT followed by TME had similar DFS rates and a trend toward longer OS compared with those with middle/lower rectal lesions . Furthermore, they indicated FOLFOX may yield superior results to a fluoropyrimidine‐based regimen during NCRT.…”

“…Furthermore, they indicated FOLFOX may yield superior results to a fluoropyrimidine‐based regimen during NCRT. NCRT might be an alternative for upper LARC patients because it results in a favorable pCR rate in such patients and comparable clinical outcomes to those of middle/lower LARC patients …”

“…On the basis of the results of a prospective randomized trial, Ngan et al concluded that long‐course neoadjuvant RT may be more effective in reducing LR for distal tumors . In Asian populations, long‐course NCRT remains the favored treatment because it can enable concurrent chemotherapy, improved sphincter preservation, and better tumor regression …”

“…11 In Asian populations, long-course NCRT remains the favored treatment because it can enable concurrent chemotherapy, improved sphincter preservation, and better tumor regression. 5,[12][13][14][15][16] The optimal regimen of chemotherapeutic agents to be administered concurrently with neoadjuvant RT for rectal cancer is undetermined. In addition, whether the use of more effective chemotherapy improves OS remains unanswered.…”