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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

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Abstract

Objective

The purpose of this study is to evaluate whether adjuvant chemotherapy could bring oncologic benefit to all patients who underwent neoadjuvant radiotherapy (30Gy/10f).

Methods

Rectal cancer patients receiving preoperative radiotherapy between July 2002 and April 2009 were retrospectively identified.

Results

A total of 225 patients were enrolled in this study. One hundred thirty-one patients received postoperative adjuvant chemotherapy, and 94 patients did not. The 120 ypN+ and 105 ypN− patients were divided into chemo and non-chemo groups. Two groups of patients did not show any significant difference in terms of gender, age, ypT stage, preoperative serum carcinoembryonic antigen (CEA) level, differentiation, circumferential margin (CRM), lymphovascular invasion (LVI), surgical approach, local recurrence, and distant metastasis (P > 0.05).

Survival analysis showed that in ypN+ patients, the 5-year overall survival (OS) rate and 5-year disease-free survival (DFS) rate in chemo group were both significantly higher than non-chemo group (P < 0.05). In ypN− patients, the 5-year OS rate and 5-year DFS rate did not show any significant difference in the two groups (P > 0.05).

Subgroup analysis showed that the 5-year OS rate and 5-year DFS rate in ypT0-2 N- patients (P > 0.05) and ypT3-4 N- patients (P > 0.05) did not show any significant difference, either.

Conclusions

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.

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References

  1. Bosset JF et al (2006) Chemotherapy with preoperative radiotherapy in rectal cancer. N Engl J Med 355(11):1114–1123

    Article  CAS  PubMed  Google Scholar 

  2. Sauer R et al (2004) Preoperative versus postoperative chemoradiotherapy for rectal cancer. N Engl J Med 351(17):1731–1740

    Article  CAS  PubMed  Google Scholar 

  3. Kapiteijn E et al (2001) Preoperative radiotherapy combined with total mesorectal excision for resectable rectal cancer. N Engl J Med 345(9):638–646

    Article  CAS  PubMed  Google Scholar 

  4. Zorcolo L et al (2012) Complete pathologic response after combined modality treatment for rectal cancer and long-term survival: a meta-analysis. Ann Surg Oncol 19(9):2822–2832

    Article  PubMed  Google Scholar 

  5. Bujko K, Glynne-Jones R, Bujko M (2010) Does adjuvant fluoropyrimidine-based chemotherapy provide a benefit for patients with resected rectal cancer who have already received neoadjuvant radiochemotherapy? A systematic review of randomised trials. Ann Oncol 21(9):1743–1750

    Article  CAS  PubMed  Google Scholar 

  6. Twelves C et al (2005) Capecitabine as adjuvant treatment for stage III colon cancer. N Engl J Med 352(26):2696–2704

    Article  CAS  PubMed  Google Scholar 

  7. Petersen SH et al (2012) Postoperative adjuvant chemotherapy in rectal cancer operated for cure. Cochrane Database Syst Rev 3:CD004078

    PubMed  Google Scholar 

  8. Du CZ et al (2009) Lymphovascular invasion in rectal cancer following neoadjuvant radiotherapy: a retrospective cohort study. World J Gastroenterol 15(30):3793–3798

    Article  PubMed Central  PubMed  Google Scholar 

  9. Fietkau R et al (2006) Postoperative chemotherapy may not be necessary for patients with ypN0-category after neoadjuvant chemoradiotherapy of rectal cancer. Dis Colon Rectum 49(9):1284–1292

    Article  PubMed  Google Scholar 

  10. Kim JS et al (2010) Adjuvant radiotherapy following total mesorectal excision for stage IIA rectal cancer: is it beneficial? Int J Color Dis 25(9):1103–1110

    Article  Google Scholar 

  11. Kiran RP et al (2012) Is adjuvant chemotherapy really needed after curative surgery for rectal cancer patients who are node-negative after neoadjuvant chemoradiotherapy? Ann Surg Oncol 19(4):1206–1212

    Article  PubMed  Google Scholar 

  12. Bosset JF et al (2014) Fluorouracil-based adjuvant chemotherapy after preoperative chemoradiotherapy in rectal cancer: long-term results of the EORTC 22921 randomised study. Lancet Oncol 15(2):184–190

    Article  CAS  PubMed  Google Scholar 

  13. Zhan T et al (2013) Intermediate-fraction neoadjuvant radiotherapy for rectal cancer. Dis Colon Rectum 56(4):422–432

    Article  PubMed  Google Scholar 

  14. Heald RJ, Husband EM, Ryall RD (1982) The mesorectum in rectal cancer surgery—the clue to pelvic recurrence? Br J Surg 69(10):613–616

    Article  CAS  PubMed  Google Scholar 

  15. (2001)Adjuvant radiotherapy for rectal cancer: a systematic overview of 8,507 patients from 22 randomised trials. Lancet 358(9290): 1291-304

  16. Figueredo A et al (2003) The use of preoperative radiotherapy in the management of patients with clinically resectable rectal cancer: a practice guideline. BMC Med 1:1

    Article  PubMed Central  PubMed  Google Scholar 

  17. Camma C et al (2000) Preoperative radiotherapy for resectable rectal cancer: a meta-analysis. JAMA 284(8):1008–1015

    Article  CAS  PubMed  Google Scholar 

  18. Beets GL, Glimelius BL (2014) Adjuvant chemotherapy for rectal cancer still controversial. Lancet Oncol 15(2):130–131

    Article  PubMed  Google Scholar 

  19. Andre T et al (2009) Improved overall survival with oxaliplatin, fluorouracil, and leucovorin as adjuvant treatment in stage II or III colon cancer in the MOSAIC trial. J Clin Oncol 27(19):3109–3116

    Article  CAS  PubMed  Google Scholar 

  20. De Stefano A et al (2014) Adjuvant treatment for locally advanced rectal cancer patients after preoperative chemoradiotherapy: when, and for whom? Clin Colorectal Cancer 13(3):185–191

    Article  PubMed  Google Scholar 

  21. Yeo SG et al (2010) Pathologic complete response of primary tumor following preoperative chemoradiotherapy for locally advanced rectal cancer: long-term outcomes and prognostic significance of pathologic nodal status (KROG 09-01). Ann Surg 252(6):998–1004

    Article  PubMed  Google Scholar 

  22. Huh JW, Kim HR (2009) Postoperative chemotherapy after neoadjuvant chemoradiation and surgery for rectal cancer: is it essential for patients with ypT0-2N0? J Surg Oncol 100(5):387–391

    Article  CAS  PubMed  Google Scholar 

  23. Hernandez JM et al (2014) The impact of pathologic nodal status on survival following neoadjuvant chemoradiation for locally advanced rectal cancer. Int J Color Dis 29(9):1061–1068

    Article  Google Scholar 

  24. Pasetto LM et al (2005) FOLFOX versus FOLFIRI: a comparison of regimens in the treatment of colorectal cancer metastases. Anticancer Res 25(1B):563–576

    CAS  PubMed  Google Scholar 

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Conflict of interest

The authors declare that they have no competing interests.

Financial disclosure

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Authors and Affiliations

  1. Key Laboratory of Carcinogenesis and Translational Research (Ministry of Education), Department of Colorectal Cancer Surgery, Peking University Cancer Hospital & Institute, 52 Fucheng Road, Haidian District, Beijing, 100142, Peoples’ Republic of China

    Pengju Chen, Yunfeng Yao & Jin Gu

  2. Peking-Tsinghua Center for Life Sciences, Beijing, Peoples’ Republic of China

    Jin Gu

Authors
  1. Pengju Chen
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  2. Yunfeng Yao
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  3. Jin Gu
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Correspondence to Jin Gu.

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Chen, P., Yao, Y. & Gu, J. Rectal cancer patients after neoadjuvant radiotherapy (30Gy/10f) with negative lymph node may not benefit from postoperative adjuvant chemotherapy: a retrospective study. Int J Colorectal Dis 30, 1695–1704 (2015). https://doi.org/10.1007/s00384-015-2358-8

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  • DOI: https://doi.org/10.1007/s00384-015-2358-8

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