Feasibility and Efficacy of Neoadjuvant Chemotherapy without Radiotherapy for Locally Advanced Rectal Cancer

Tokuhara, Katsuji; Matsui, Yoshihiko; Ueyama, Yosuke; Yoshioka, Kazuhiko; Sekimoto, Mitsugu

doi:10.23922/jarc.2021-033

Cited by 3 publications

(3 citation statements)

References 25 publications

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“…Besides, the effects of neoadjuvant chemotherapy alone on perioperative safety, 45 tumor prognosis, 46 and bowel function 47,48 have been studied and discussed in recent years, and its feasibility was confirmed. Some scholars even tried to explore the efficacy of selective radiotherapy based on neoadjuvant chemotherapy.…”

Section: Discussionmentioning

confidence: 99%

Effects of Preoperative Radiotherapy on Long-Term Bowel Function in Patients With Rectal Cancer Treated With Anterior Resection: A Systematic Review and Meta-analysis

Liang

Zhang

et al. 2022

Technol Cancer Res Treat

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Background: Anterior resection is a common surgical approach used in rectal cancer surgery; however, this procedure is known to cause bowel injury and dysfunction. Neoadjuvant therapy is widely used in patients with locally advanced rectal cancer. In this study, we determined the effect of preoperative radiotherapy on long-term bowel function in patients who underwent anterior resection for treatment of rectal cancer. Methods: We performed a comprehensive literature search of the PubMed, Embase, Web of Science, and the Cochrane Library databases. A random-effects model was used in the meta-analysis by the Review Manager software, version 5.3. Results: This systematic review and meta-analysis included 12 studies, which used low anterior resection syndrome score with a total of 2349 patients. Based on them, we concluded that low anterior resection syndrome was significantly more common in the preoperative radiotherapy group (odds ratio 3.59, 95% confidence interval 2.68-4.81, P < .00001) and that major low anterior resection syndrome also occurred significantly more frequently in the preoperative radiotherapy group (odds ratio 3.28, 95% confidence interval 2.05-5.26, P < .00001). Subgroup analyses of long-course radiation, total mesorectal excision, and non-metastatic tumors were performed, and the results met the conclusions of the primary outcomes. Conclusions: Preoperative radiotherapy negatively affects long-term bowel function in patients who undergo anterior resection for rectal cancer.

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Section: Discussionmentioning

confidence: 99%

Effects of Preoperative Radiotherapy on Long-Term Bowel Function in Patients With Rectal Cancer Treated With Anterior Resection: A Systematic Review and Meta-analysis

Liang

Zhang

et al. 2022

Technol Cancer Res Treat

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“…Интересное исследование проведено K. Tokuhara и соавт. [49], которые в зависимости от RAS-статуса пациентов проводили НАХТ в режимах mFOLFOX6/SOX в сочетании с цетуксимабом (n=12) или FOLFOXIRI/SOXIRI (n=18). Общая завершенность химиотерапии и резектабельность составили 90 и 100% соответственно.…”

Section: нахт в сочетании с таргетными препаратамиunclassified

Neoadjuvant chemotherapy for treatment patients with rectal cancer with adverse prognostic factors: A review

Nevolskikh

Avdeenko²,

Belokhvostova³

et al. 2022

J. Mod. Onco.

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Rectal cancer (RC) is one of the leading tumor location in the structure of the incidence of malignant neoplasms in the Russian Federation and the world. And the standard approach to the treatment of patients with locally advanced forms of RC is preoperative chemo-radiotherapy (CRT) with delayed surgery. The use of such sort of approach in the recent decades has led to the reduction of the frequency of local recurrence up to 10% and even less. However, approximately a third of patients die of distant metastases. In this regard, one of the main tasks in the treatment of patients with locally advanced forms of RC with adverse prognostic factors is the prevention of distant metastasis formation. Early initiation of the systemic therapy before surgery is aimed at solving this issue. Conducting neoadjuvant chemotherapy (NCT) instead of CRT in RC treatment allows to avoid radiation reactions and injuries, occurring in some patients. Two-component oxaliplatin-containing regimens are the most well studied types of NCT in the treatment of patients with non-metastatic RC. In this connection, despite the differences in the treatment regimens and the number of cycles, a good tolerability of the method as well as no effect on the frequency of postoperative complications and in general a satisfactory results comparable to the effects of CRT were observed. The use of NCT in combination with targeted treatment modalities as well as three-component chemotherapy regimens are promising and encouraging treatment options for patients with RC with adverse prognostic factors.

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“…In cases of resectable LARC, neoadjuvant chemoradiotherapy (NACRT), followed by total mesorectum excision (TME), is now thought to be the best strategy in Western countries (3,6,7). However, preoperative treatment for LARC is not a mainstay in Japan (8)(9)(10). Despite such strategies, LARC still has a local-recurrence rate of 5-10%, even after curative-intent resection (11)(12)(13)(14)(15).…”

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confidence: 99%

Positive Circumferential Resection Margin in Rectal Cancer Is a Robust Predictor of Poor Long-term Prognosis With Clinicopathological Bias Between Groups Compensated by Propensity-score Matching Analysis

Sugimoto¹,

Takahashi²,

Yuki³

et al. 2023

Anticancer Res

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Background/Aim: Circumferential resection margin (CRM) is the most reliable predictor of local and distant recurrence in locally-advanced rectal cancer (LARC). The present study was conducted to compare the long-term outcomes between CRM (+) and (-) groups using propensity-score (PS) matching analysis to compensate for bias between groups. Patients and Methods: Of 563 consecutive patients with Stage II/III rectal cancer who were treated surgically with curativeintent at Juntendo University Hospital between Jan 1989 and Mar 2018, 412 patients were enrolled retrospectively in the study. The patients were divided into a CRM (+) group (n=21; 5.1%) and a CRM (-) group (n=391; 94.9%). Results: In the entire cohort, recurrence-free survival (RFS), local recurrencefree survival (LRFS), non-local recurrence-free survival (NLRFS), and cancer-specific survival (CSS) were significantly worse among patients in the CRM (+) group compared with those in the CRM (-) group. Univariate analysis demonstrated patients in the CRM (+) group had significantly larger primary tumors (p=0.02), more frequently had open surgery (p=0.009), had an abdominoperineal resection (APR) procedure (p=0.01) and a T4 primary tumor (p<0.0001). After PS matching analysis, in the propensity-matched cohort, RFS, LRFS, NLRFS and CSS were significantly worse among patients in the CRM (+) group compared with those in the CRM (-) group. Conclusion: PS matching analysis demonstrated that RFS, LRFS, NLRFS, and CSS were significantly worse among patients in the CRM (+) group compared with those in the CRM (-) group. The present results indicate that CRM (+) is a robust predictor of long-term outcome of LARC, independent of tumor size.

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Feasibility and Efficacy of Neoadjuvant Chemotherapy without Radiotherapy for Locally Advanced Rectal Cancer

Cited by 3 publications

References 25 publications

Effects of Preoperative Radiotherapy on Long-Term Bowel Function in Patients With Rectal Cancer Treated With Anterior Resection: A Systematic Review and Meta-analysis

Effects of Preoperative Radiotherapy on Long-Term Bowel Function in Patients With Rectal Cancer Treated With Anterior Resection: A Systematic Review and Meta-analysis

Neoadjuvant chemotherapy for treatment patients with rectal cancer with adverse prognostic factors: A review

Positive Circumferential Resection Margin in Rectal Cancer Is a Robust Predictor of Poor Long-term Prognosis With Clinicopathological Bias Between Groups Compensated by Propensity-score Matching Analysis

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