Postoperative Chemotherapy May Not Be Necessary for Patients With ypN0-Category After Neoadjuvant Chemoradiotherapy of Rectal Cancer

Fietkau, Rainer; M, Barten; Klautke, Günther; Klar, E.; Ludwig, Kaja; Thomas, H.; Brinckmann, W; Friedrich, K. Andreas; Prall, Friedrich; Hartung, G.; Küchenmeister, Ute; Kundt, Günther

doi:10.1007/s10350-006-0570-x

Cited by 101 publications

(60 citation statements)

References 35 publications

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“…Although patients who treated with postoperative chemotherapy had higher 5-year overall survival and disease-free survival rates compared with patients who were not treated postoperatively, the differences between the groups were not statistically significant. These findings are consistent with the suggestion by Das et al [4] that postoperative chemotherapy may be of greater benefit for high-risk patients, and the recommendation by Fietkau et al [5], who reported that postoperative chemotherapy may be unnecessary in patients with ypN0. However, the results are contrary to those of Janjan et al [6], who found a significant improvement in cancer-specific survival in response to neoadjuvant chemoradiotherapy and the administration of postoperative chemotherapy.…”

Section: To the Editorsupporting

confidence: 90%

Postoperative adjuvant chemotherapy in patients with ypN+ after preoperative chemoradiation for rectal cancer: Need for randomized trials

Huh

2011

Journal of Surgical Oncology

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Section: To the Editorsupporting

confidence: 90%

Postoperative adjuvant chemotherapy in patients with ypN+ after preoperative chemoradiation for rectal cancer: Need for randomized trials

Huh

2011

Journal of Surgical Oncology

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“…As a result, it appears logical to treat these patients aggressively with adjuvant chemotherapy [55,59,6365] . Unfortunately, Breugom et al [36] in the metaanalysis of five trials (described above) showed no benefit of adjuvant chemotherapy neither in stage Ⅱnor in stage Ⅲ, however there was no data available for stage 0 and Ⅰ disease.…”

Section: Milinis K Et Al Adjuvant Chemotherapy In Rectal Cancermentioning

confidence: 99%

Adjuvant chemotherapy for rectal cancer: Is it needed?

Milinis

Thornton

Montazeri

et al. 2015

WJCO

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Adjuvant chemotherapy has become a standard treatment of advanced rectal cancer in the West. The benefits of adjuvant chemotherapy after surgery alone have been well established. However, controversy surrounds the use adjuvant chemotherapy in patients who received preoperative chemoradiotherapy, despite it being recommended by a number of international guidelines. Results of recent multicentre randomised control trials showed no benefit of adjuvant chemotherapy in terms of survival and rates of distant metastases. However, concerns exist regarding the quality of the studies including inadequate staging modalities, out-dated chemotherapeutic regimens and surgical approaches and small sample sizes. It has become evident that not all the patients respond to adjuvant chemotherapy and more personalised approach should be employed when considering the benefits of adjuvant chemotherapy. The present review discusses the strengths and weaknesses of the current evidence-base and suggests improvements for future studies.

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“…112,113 The need for adjuvant CT in patients with a complete or near-complete response after CRT has been questioned. 114,115 Recent work from a multi-institutional retrospective analysis of 3,133 patients shows that the benefit of adjuvant therapy differs between LARC subgroups. For example, patients with ypT1-2 or ypT3-4 tumors benefitted the most from adjuvant therapy compared with patients who had ypT0N0 tumors.…”

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confidence: 99%

Advances and Challenges in Treatment of Locally Advanced Rectal Cancer

Smith

Garcia‐Aguilar

2015

JCO

166

114

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Dramatic improvements in the outcomes of patients with rectal cancer have occurred over the past 30 years. Advances in surgical pathology, refinements in surgical techniques and instrumentation, new imaging modalities, and the widespread use of neoadjuvant therapy have all contributed to these improvements. Several questions emerge as we learn of the benefits or lack thereof for components of the current multimodality treatment in subgroups of patients with nonmetastatic locally advanced rectal cancer (LARC). What is the optimal surgical technique for distal rectal cancers? Do all patients need postoperative chemotherapy? Do all patients need radiation? Do all patients need surgery, or is a nonoperative, organ-preserving approach warranted in selected patients? Answering these questions will lead to more precise treatment regimens, based on patient and tumor characteristics, that will improve outcomes while preserving quality of life. However, the idea of shifting the treatment paradigm (chemoradiotherapy, total mesorectal excision, and adjuvant therapy) currently applied to all patients with LARC to a more individually tailored approach is controversial. The paradigm shift toward organ preservation in highly selected patients whose tumors demonstrate clinical complete response to neoadjuvant treatment is also controversial. Herein, we highlight many of the advances and resultant controversies that are likely to dominate the research agenda for LARC in the modern era.

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Postoperative Chemotherapy May Not Be Necessary for Patients With ypN0-Category After Neoadjuvant Chemoradiotherapy of Rectal Cancer

Abstract: These retrospective data suggest that, for some patients, postoperative chemotherapy can be spared. For patients with ypN2 status, an intensification of the postoperative chemotherapy should be considered. Further evaluation in prospective studies is urgently recommended.

Cited by 101 publications

References 35 publications

Postoperative adjuvant chemotherapy in patients with ypN+ after preoperative chemoradiation for rectal cancer: Need for randomized trials

Postoperative adjuvant chemotherapy in patients with ypN+ after preoperative chemoradiation for rectal cancer: Need for randomized trials

Adjuvant chemotherapy for rectal cancer: Is it needed?

Advances and Challenges in Treatment of Locally Advanced Rectal Cancer

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