Rectal cancer patients after neoadjuvant radiotherapy (30Gy/10f) with negative lymph node may not benefit from postoperative adjuvant chemotherapy: a retrospective study

Chen, Pengju; Yao, Yunfeng; Gu, Jin

doi:10.1007/s00384-015-2358-8

Cited by 6 publications

(12 citation statements)

References 23 publications

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“…In locally advanced rectal cancer, neoadjuvant chemoradiotherapy with a total mesorectal excision is the standard of treatment, as it can downstage the disease [6,[10][11][12][14][15][16]. Furthermore, reduction in the lymph node staging is seen in 30-60% of lymph node-positive patients [16,[20][21][22][23].…”

Section: Discussionmentioning

confidence: 99%

“…The use of adjuvant chemotherapy especially in the context of previous neoadjuvant treatment, is controversial . Fluoropyrimidine‐based adjuvant chemotherapy has been widely used, and the addition of oxaliplatin was based on data from patients with colon cancer . For many years colon and rectal cancers were considered as a single entity and much of the evidence looking at the use of adjuvant therapy in rectal cancer is taken from studies looking at colon and rectal cancer together.…”

Section: Introductionmentioning

confidence: 99%

“…Fluoropyrimidine‐based adjuvant chemotherapy has been widely used, and the addition of oxaliplatin was based on data from patients with colon cancer . For many years colon and rectal cancers were considered as a single entity and much of the evidence looking at the use of adjuvant therapy in rectal cancer is taken from studies looking at colon and rectal cancer together. This was based on the logic that they are histologically similar and are in organ continuity .…”

Section: Introductionmentioning

confidence: 99%

“…For many years colon and rectal cancers were considered as a single entity and much of the evidence looking at the use of adjuvant therapy in rectal cancer is taken from studies looking at colon and rectal cancer together. This was based on the logic that they are histologically similar and are in organ continuity . However, they should be considered separately as the rectum is deep in the pelvis and is covered by surrounding tissue on all sides.…”

Section: Introductionmentioning

confidence: 99%

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The effect of adjuvant chemotherapy on survival and recurrence after curative rectal cancer surgery in patients who are histologically node negative after neoadjuvant chemoradiotherapy

et al. 2017

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This study found no significant difference in survival or disease recurrence between patients who received adjuvant chemotherapy and patients who did not. There is no clear evidence to support or dismiss the use of adjuvant chemotherapy for patients who were node positive on preoperative MRI and node negative on histopathological staging. Further multicentre prospective randomized trials are needed to identify the appropriate treatment regime for this group of patients.

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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The effect of adjuvant chemotherapy on survival and recurrence after curative rectal cancer surgery in patients who are histologically node negative after neoadjuvant chemoradiotherapy

et al. 2017

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“…For patients with LARC who underwent NCRT followed by curative surgery, ypN stage is regarded as the strongest independent prognostic factor influencing oncological outcomes [ 29 ]. Several studies analysed the prognostic value of adjuvant chemotherapy for patients with ypN– and ypN+ tumors and found that adjuvant chemotherapy may be unnecessary for those with ypN– disease and that only patients with ypN+ tumors were candidates for adjuvant chemotherapy [ 14 , 18 ]. Pathological T stage is also a powerful prognostic predictor.…”

Section: Discussionmentioning

confidence: 99%

Is adjuvant chemotherapy necessary for patients with ypT0–2N0 rectal cancer treated with neoadjuvant chemoradiotherapy and curative surgery?

Cheng

Zhang

et al. 2018

Gastroenterology Report

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Background and objectiveThe benefit from adjuvant chemotherapy for patients treated with neoadjuvant chemoradiotherapy (NCRT) and curative surgery remains controversial, particularly among those responding well to NCRT. This retrospective study aimed to clarify the benefits of adjuvant chemotherapy in terms of the oncological outcomes of patients with ypT0–2N0 rectal cancer after NCRT and curative surgery.MethodsAll patients with ypT0–2N0 rectal cancer after NCRT and curative resection between 2005 and 2014 were examined. The oncological outcomes between patients treated with adjuvant chemotherapy and those without any chemotherapy were compared.ResultsThe clinicopathological characteristics of 110 patients were reviewed in this study; one patient was excluded due to lack of follow-up. Of the 109 patients included, 58 (53.2%) underwent adjuvant chemotherapy (chemo group), whereas the remaining 51 (46.8%) did not receive any chemotherapy (non-chemo group). After a median follow-up of 50 months, there were no significant differences in the 5-year overall survival (OS) or recurrence-free survival (RFS) rates between the groups (OS: 92.1 vs 86.3%, P = 0.375; RFS: 80.9 vs 74.7%, P = 0.534). Subgroup analysis also demonstrated no significant differences in 5-year OS and RFS rates between patients with ypT0N0 rectal cancer (P = 0.712 and P = 0.599, respectively) and those with ypT1–2N0 disease (P = 0.255 and P = 0.278, respectively).ConclusionsThese results indicate that patients with ypT0–2N0 rectal cancer after NCRT followed by curative surgery may not derive significant benefit from adjuvant chemotherapy. However, further prospective randomized trials, with larger sample sizes, are warranted to confirm this conclusion.

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Factors associated with metachronous metastases and survival in locally advanced and recurrent rectal cancer

et al. 2020

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Background: Better understanding of the impact of metachronous metastases in locally advanced and recurrent rectal cancer may improve decision-making. The aim of this study was to investigate factors influencing metachronous metastasis and its impact on survival in patients who have a beyond total mesorectal excision (bTME) operation. Methods: This was a retrospective study of consecutive patients who had bTME surgery for locally advanced and recurrent rectal cancer at a tertiary referral centre between January 2006 and December 2016. The primary outcome was overall survival. Cox proportional hazards regression analyses were performed. The influence of metachronous metastases on survival was investigated. Results: Of 220 included patients, 171 were treated for locally advanced primary tumours and 49 for recurrent rectal cancer. Some 90⋅0 per cent had a complete resection with negative margins. Median follow-up was 26⋅0 (range 1⋅5-119⋅6) months. The 5-year overall survival rate was 71⋅1 per cent. Local recurrence and metachronous metastasis rates were 11⋅8 and 22⋅2 per cent respectively. Patients with metachronous metastases had a worse overall survival than patients without metastases (median 52⋅9 months versus estimated mean 109⋅4 months respectively; hazard ratio (HR) 6⋅73, 95 per cent c.i. 3⋅23 to 14⋅00). Advancing pT category (HR 2⋅01, 1⋅35 to 2⋅98), pN category (HR 2⋅43, 1⋅65 to 3⋅59), vascular invasion (HR 2⋅20, 1⋅22 to 3⋅97) and increasing numbers of positive lymph nodes (HR 1⋅19, 1⋅07 to 1⋅16) increased the risk of metachronous metastasis. Nine of 17 patients (53 per cent) with curatively treated synchronous metastases at presentation developed metachronous metastases, compared with 40 of 203 (19⋅7 per cent) without synchronous metastases (P = 0⋅002). Corresponding median length of disease-free survival was 17⋅5 versus 90⋅8 months (P < 0⋅001). Conclusion: As metachronous metastases impact negatively on survival after bTME surgery, factors associated with metachronous metastases may serve as selection tools when determining suitability for treatment with curative intent.

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Rectal cancer patients after neoadjuvant radiotherapy (30Gy/10f) with negative lymph node may not benefit from postoperative adjuvant chemotherapy: a retrospective study

Abstract: Based on a Chinese protocol, patients with ypN- stage may not benefit from adjuvant chemotherapy, regardless of the ypT stage, while the ypN+ patients may benefit from adjuvant chemotherapy. More randomized clinical trials are needed in the future.

Cited by 6 publications

References 23 publications

The effect of adjuvant chemotherapy on survival and recurrence after curative rectal cancer surgery in patients who are histologically node negative after neoadjuvant chemoradiotherapy

The effect of adjuvant chemotherapy on survival and recurrence after curative rectal cancer surgery in patients who are histologically node negative after neoadjuvant chemoradiotherapy

Is adjuvant chemotherapy necessary for patients with ypT0–2N0 rectal cancer treated with neoadjuvant chemoradiotherapy and curative surgery?

Factors associated with metachronous metastases and survival in locally advanced and recurrent rectal cancer

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