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Impact of Postoperative Adjuvant Chemotherapy Following Long-course Chemoradiotherapy in Stage II Rectal Cancer
- Source :
- American Journal of Clinical Oncology. 41:643-648
- Publication Year :
- 2018
- Publisher :
- Ovid Technologies (Wolters Kluwer Health), 2018.
-
Abstract
- Use of adjuvant chemotherapy (AC) following neoadjuvant chemoradiation (nCRT) is controversial in rectal cancer (RC). We assessed a multi-institutional database to determine if there was benefit from AC for pathologic stage II RC patients and whether the addition of oxaliplatin to fluoropyrimidine (OXAC) therapy impacted outcomes.We included patients who underwent nCRT and had pathologic stage II (ypT3/4 ypN0) tumors. Disease-free survival and overall survival were assessed. Multivariate Cox models adjusting for age, sex, Eastern Cooperative Oncology Group, high-risk features (pT4, poor differentiation,12 nodes removed, lymphovascular/perineural invasion, or obstruction/perforation), and clinical stage were constructed.Of 485 patients, 73.6% received AC, of which 25.5% received OXAC. Patients receiving AC were younger (median age 61 vs. 64; P=0.003) and had higher rates of total mesorectal excision (81.5% vs. 78.9%; P=0.049), but had similar high-risk features, performance status, clinical stage, margin status, preoperative carcinoembryonic antigen, and nCRT regimen. In univariate analysis, overall survival was improved with fluoropyrimidine AC compared with no AC or OXAC (P=0.049), but not disease-free survival (P=0.33). In multivariate analysis, any AC, fluoropyrimidine AC, or OXAC did not improve outcomes. After stratifying patients by the presence of high-risk features, elevated carcinoembryonic antigen, margin status, or preoperative clinical stage, we did not identify a group with improved outcomes following AC.In this multi-institutional cohort of yp stage II RC patients, we failed to identify a group that derives benefit from AC following nCRT. The addition of oxaliplatin did not appear to improve outcomes when compared with fluoropyrimidine alone.
- Subjects :
- Male
Oncology
Cancer Research
medicine.medical_specialty
Colorectal cancer
Adjuvant chemotherapy
Locally advanced
030230 surgery
Cohort Studies
03 medical and health sciences
0302 clinical medicine
Internal medicine
Antineoplastic Combined Chemotherapy Protocols
medicine
Humans
Stage II Rectal Cancer
Aged
Neoplasm Staging
Postoperative Care
Salvage Therapy
Pathologic stage
Rectal Neoplasms
business.industry
Chemoradiotherapy
Middle Aged
Prognosis
medicine.disease
Oxaliplatin
Survival Rate
Chemotherapy, Adjuvant
030220 oncology & carcinogenesis
Female
Neoplasm Recurrence, Local
business
Follow-Up Studies
medicine.drug
Subjects
Details
- ISSN :
- 02773732
- Volume :
- 41
- Database :
- OpenAIRE
- Journal :
- American Journal of Clinical Oncology
- Accession number :
- edsair.doi.dedup.....698a9fd12ffe14afe97378b98801db8f
- Full Text :
- https://doi.org/10.1097/coc.0000000000000342