Skip to main content

Advertisement

Log in

Adjuvant chemotherapy after neoadjuvant chemoradiation and surgery: A quest to improve survival for stage II and III rectal cancer

  • Published:
Current Colorectal Cancer Reports

Abstract

Combined multimodality treatments, including radiation, chemotherapy, and total mesorectal excision have been studied extensively over the past few decades, with efforts toward improving rates of locoregional recurrence and disease-free and overall survival in rectal cancer. Predictive and prognostic markers to adjuvant systemic chemotherapy have been identified, with the goal of tailoring therapy and continuing improvement in survival. In our article, we discuss these factors, including tumor downstaging, pathologic node status, gene expression, and future directions in therapy of rectal cancer.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Similar content being viewed by others

References and Recommended Reading

  1. Fisher B, Wolmark N, Rockette H, et al.: Postoperative adjuvant chemotherapy or radiation therapy for rectal cancer: results from NSABP protocol R-01. J Natl Cancer Inst 1988, 80:21–29.

    Article  PubMed  CAS  Google Scholar 

  2. Heald RJ, Moran BJ, Ryall RD, et al.: Rectal cancer: the Basingstoke experience of total mesorectal excision, 1978–1997. Arch Surg 1998, 133:894–899.

    Article  PubMed  CAS  Google Scholar 

  3. Heald RJ, Husband EM, Ryall RD: The mesorectum in rectal cancer surgery—the clue to pelvic recurrence? Br J Surg 1982, 69:613–616.

    Article  PubMed  CAS  Google Scholar 

  4. MacFarlane JK, Ryall RD, Heald RJ: Mesorectal excision for rectal cancer. Lancet 1993, 341:457–460.

    Article  PubMed  CAS  Google Scholar 

  5. Enker WE, Thaler HT, Cranor ML, Polyak T: Total mesorectal excision in the operative treatment of carcinoma of the rectum. J Am Coll Surg 1995, 181:335–346.

    PubMed  CAS  Google Scholar 

  6. Improved survival with preoperative radiotherapy in resectable rectal cancer. Swedish Rectal Cancer Trial. N Engl J Med 1997, 336:980–987. [Published erratum appears in N Engl J Med 1997, 336:1539.]

  7. Kapiteijn E, Marijnen CA, Nagtegaal ID, et al.: Preoperative radiotherapy combined with total mesorectal excision for resectable rectal cancer. N Engl J Med 2001, 345:638–646.

    Article  PubMed  CAS  Google Scholar 

  8. Gerard JP, Conroy T, Bonnetain F, et al.: Preoperative radiotherapy with or without concurrent fluorouracil and leucovorin in T3-4 rectal cancers: results of FFCD 9203. J Clin Oncol 2006, 24:4620–4625.

    Article  PubMed  Google Scholar 

  9. Sauer R, Becker H, Hohenberger W, et al.: Preoperative versus postoperative chemoradiotherapy for rectal cancer. N Engl J Med 2004, 351:1731–1740.

    Article  PubMed  CAS  Google Scholar 

  10. Bosset JF, Collette L, Calais G, et al.: Chemotherapy with preoperative radiotherapy in rectal cancer. N Engl J Med 2006, 355:1114–1123. [Published erratum appears in N Engl J Med 2007, 357:1114–1123.]

    Article  PubMed  CAS  Google Scholar 

  11. Collette L, Bosset JF, den Dulk M, et al.: Patients with curative resection of cT3-4 rectal cancer after preoperative radiotherapy or radiochemotherapy: does anybody benefit from adjuvant fluorouracil-based chemotherapy? A trial of the European Organisation for Research and Treatment of Cancer Radiation Oncology Group. J Clin Oncol 2007, 25:4379–4386.

    Article  PubMed  CAS  Google Scholar 

  12. Janjan NA, Crane C, Feig BW, et al.: Improved overall survival among responders to preoperative chemoradiation for locally advanced rectal cancer. Am J Clin Oncol 2001, 24:107–112.

    Article  PubMed  CAS  Google Scholar 

  13. Das P, Skibber JM, Rodriguez-Bigas MA, et al.: Clinical and pathologic predictors of locoregional recurrence, distant metastasis, and overall survival in patients treated with chemoradiation and mesorectal excision for rectal cancer. Am J Clin Oncol 2006, 29:219–224.

    Article  PubMed  Google Scholar 

  14. Chan AK, Wong AO, Langevin J, et al.: Preoperative chemotherapy and pelvic radiation for tethered or fixed rectal cancer: a phase II dose escalation study. Int J Radiat Oncol Biol Phys 2000, 48:843–856.

    PubMed  CAS  Google Scholar 

  15. Fietkau R, Barten M, Klautke G, et al.: Postoperative chemotherapy may not be necessary for patients with ypN0-category after neoadjuvant chemoradiotherapy of rectal cancer. Dis Colon Rectum 2006, 49:1284–1292.

    Article  PubMed  Google Scholar 

  16. Saw RP, Morgan M, Koorey D, et al.: p53, deleted in colorectal cancer gene, and thymidylate synthase as predictors of histopathologic response and survival in low, locally advanced rectal cancer treated with preoperative adjuvant therapy. Dis Colon Rectum 2003, 46:192–202.

    Article  PubMed  Google Scholar 

  17. Jernvall P, Makinen MJ, Karttunen TJ, et al.: Loss of heterozygosity at 18q21 is indicative of recurrence and therefore poor prognosis in a subset of colorectal cancers. Br J Cancer 1999, 79:903–908.

    Article  PubMed  CAS  Google Scholar 

  18. Guerra A, Borda F, Javier Jimenez F, et al.: Multivariate analysis of prognostic factors in resected colorectal cancer: a new prognostic index. Eur J Gastroenterol Hepatol 1998, 10:51–58.

    Article  PubMed  CAS  Google Scholar 

  19. Colombino M, Cossu A, Manca A, et al.: Prevalence and prognostic role of microsatellite instability in patients with rectal carcinoma. Ann Oncol 2002, 13:1447–1453.

    Article  PubMed  CAS  Google Scholar 

  20. Uen YH, Lin SR, Wu DC, et al.: Prognostic significance of multiple molecular markers for patients with stage II colorectal cancer undergoing curative resection. Ann Surg 2007, 246:1040–1046.

    Article  PubMed  Google Scholar 

  21. Johnston PG, Fisher ER, Rockette HE, et al.: The role of thymidylate synthase expression in prognosis and outcome of adjuvant chemotherapy in patients with rectal cancer. J Clin Oncol 1994, 12:2640–2647.

    PubMed  CAS  Google Scholar 

  22. Ghadimi BM, Grade M, Difilippantonio MJ, et al.: Effectiveness of gene expression profiling for response prediction of rectal adenocarcinomas to preoperative chemoradiotherapy. J Clin Oncol 2005, 23:1826–1838.

    Article  PubMed  CAS  Google Scholar 

  23. Swain SM, Lippman ME, Egan EF, et al.: Fluorouracil and high-dose leucovorin in previously treated patients with metastatic breast cancer. J Clin Oncol 1989, 7:890–899.

    PubMed  CAS  Google Scholar 

  24. Danenberg PV: Thymidylate synthase: a target enzyme in cancer chemotherapy. Biochim Biophys Acta 1977, 473:73–92.

    PubMed  CAS  Google Scholar 

  25. Santi DV, McHenry CS, Sommer M: Mechanisms of interaction of thymidylate synthase with 5-fluorodeoxyuridylate. Biochemistry 1974, 13:471–480.

    Article  PubMed  CAS  Google Scholar 

  26. Santi DV, Danenberg PV: Mechanisms of interaction of thymidylate synthase with 5-fluorodeoxyuridylate folates in pyrimidine nucleotide biosynthesis. In Folates and Pterins. Edited by Blakely RL, Benkovic SJ. New York: Wiley; 1984:385–398.

    Google Scholar 

  27. Berger SH, Jenh CH, Johnson LF, Berger FG: Thymidylate synthase overproduction and gene amplification in fluorodeoxyuridine-resistant human cells. Mol Pharmacol 1985, 28:461–467.

    PubMed  CAS  Google Scholar 

  28. Clark JL, Berger SH, Mittelman A, Berger FG: Thymidylate synthase gene amplification in a colon tumor resistant to fluoropyrimidine chemotherapy. Cancer Treat Rep 1987, 71:261–265.

    PubMed  CAS  Google Scholar 

  29. Spears CP, Shahinian AH, Moran RG, et al.: In vivo kinetics of thymidylate synthetase inhibition of 5-fluorouracil-sensitive and -resistant murine colon adenocarcinomas. Cancer Res 1982, 42:450–456.

    PubMed  CAS  Google Scholar 

  30. Washtein WL: Increased levels of thymidylate synthase in cells exposed to 5-fluorouracil. Mol Pharmacol 1984, 25:171–177.

    Google Scholar 

  31. Johnston PG, Drake JC, Trepel J, Allegra CJ: Immunological quantitation of thymidylate synthase using the monoclonal antibody TS 106 in 5-fluorouracil-sensitive and -resistant human cancer cell lines. Cancer Res 1992, 52:4306–4312.

    PubMed  CAS  Google Scholar 

  32. Chu E, Koeller DM, Johnston PG, et al.: Regulation of thymidylate synthase in human colon cancer cells treated with 5-fluorouracil and interferon-gamma. Mol Pharmacol 1993, 43:527–533.

    PubMed  CAS  Google Scholar 

  33. Liersch T, Langer C, Ghadimi BM, et al.: Lymph node status and TS gene expression are prognostic markers in stage II/III rectal cancer after neoadjuvant fluorouracil-based chemoradiotherapy. J Clin Oncol 2006, 24:4062–4068.

    Article  PubMed  CAS  Google Scholar 

  34. Andre T, Boni C, Mounedji-Boudiaf L, et al.: Oxaliplatin, fluorouracil, and leucovorin as adjuvant treatment for colon cancer. N Engl J Med 2004, 350:2343–2351.

    Article  PubMed  CAS  Google Scholar 

  35. Freyer G, Bossard N, Romestaing P, et al.: Addition of oxaliplatin to continuous fluorouracil, l-folinic acid, and concomitant radiotherapy in rectal cancer: the Lyon R 97-03 phase I trial. J Clin Oncol 2001, 19:2433–2438.

    PubMed  CAS  Google Scholar 

  36. Sebag-Montefiore D, Glynne-Jones R, Falk S, et al.: A phase I/II study of oxaliplatin when added to 5-fluorouracil and leucovorin and pelvic radiation in locally advanced rectal cancer: a Colorectal Clinical Oncology Group (CCOG) study. Br J Cancer 2005, 93:993–998.

    Article  PubMed  CAS  Google Scholar 

  37. Aschele C, Friso ML, Pucciarelli S, et al.: A phase I–II study of weekly oxaliplatin, 5-fluorouracil continuous infusion and preoperative radiotherapy in locally advanced rectal cancer. Ann Oncol 2005, 16:1140–1146.

    Article  PubMed  CAS  Google Scholar 

  38. Ryan DP, Niedzwiecki D, Hollis D, et al.: Phase I/II study of preoperative oxaliplatin, fluorouracil, and external-beam radiation therapy in patients with locally advanced rectal cancer: Cancer and Leukemia Group B 89901. J Clin Oncol 2006, 24:2557–2562.

    Article  PubMed  CAS  Google Scholar 

  39. Minsky BD: Adjuvant management of rectal cancer: the more we learn, the less we know. J Clin Oncol 2007, 25:4339–4340.

    Article  PubMed  Google Scholar 

Download references

Author information

Authors and Affiliations

Authors

Corresponding author

Correspondence to Al B. Benson III.

Rights and permissions

Reprints and permissions

About this article

Cite this article

Vergo, M., Nimeiri, H. & Benson, A.B. Adjuvant chemotherapy after neoadjuvant chemoradiation and surgery: A quest to improve survival for stage II and III rectal cancer. Curr colorectal cancer rep 5, 151–157 (2009). https://doi.org/10.1007/s11888-009-0022-9

Download citation

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s11888-009-0022-9

Keywords

Navigation