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Total Neoadjuvant Therapy in Rectal Cancer: Multi-center Comparison of Induction Chemotherapy and Long-Course Chemoradiation Versus Short-Course Radiation and Consolidative Chemotherapy

  • Original Article
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Journal of Gastrointestinal Surgery

Abstract

Background

Total neoadjuvant therapy for locally advanced rectal cancer may include induction chemotherapy and chemoradiation or short-course radiotherapy and consolidative chemotherapy.

Methods

Patients with clinical stage 2 or 3 rectal cancer who received induction chemotherapy followed by long-course chemoradiation at the University of Colorado (2016–2020) or short-course radiotherapy followed by consolidative chemotherapy at Washington University (2017–2020) were assessed.

Results

Eighty-four patients received induction chemotherapy and chemoradiation and 83 received short-course radiotherapy and consolidative chemotherapy. Among patients with complete re-staging evaluation, clinical complete response rates were similar, 49% (18/37) and 53% (44/83), respectively (p = 0.659). In the induction chemotherapy and chemoradiation group, 80% (n = 67) underwent surgery and 28% (n = 19) achieved a pathologic complete response. In the short-course radiotherapy and consolidative chemotherapy group, 44 (53%) patients underwent surgery and 11% (n = 5) had a pathologic complete response. Overall, a complete response was observed in 43% (n = 36) of patients who received induction chemotherapy and chemoradiation compared to 53% (n = 44) who received short-course radiotherapy and consolidative chemotherapy (p = 0.189). Perioperative outcomes were similar in patients who received induction chemotherapy and chemoradiation compared to short-course radiotherapy and consolidative chemotherapy: intraoperative complications (2% vs 7%), complete mesorectal specimen (85% vs 84%), anastomotic leak (9% vs 7%), organ/space infection (9% vs 5%), readmission (19% vs 21%), and reoperation (8% vs 9%), respectively (all p > 0.05).

Conclusions

In patients with clinical stage 2 or 3 rectal cancer, total neoadjuvant therapy with either induction chemotherapy and chemoradiation or short-course radiotherapy followed by consolidative chemotherapy were associated with similar perioperative morbidity and complete response rates.

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Data Availability

The datasets generated during and/or analysed during the current study are available from the corresponding author on reasonable request.

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Authors and Affiliations

  1. Department of Surgery, University of Colorado Denver School of Medicine, 12631 E. 17Th Ave., C313, Aurora, CO, 80045, USA

    Amber M. Moyer, Jon D. Vogel, Samuel H. Lai, Marina Moskalenko, Jeffrey R. Olsen, Elisa H. Birnbaum & Brandon C. Chapman

  2. Department of Surgery, Washington University in St. Louis School of Medicine, St. Louis, MO, USA

    Hyun Kim, Re-I Chin, Matthew L. Silviera & Matthew G. Mutch

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  1. Amber M. Moyer
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  2. Jon D. Vogel
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  4. Hyun Kim
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All authors contributed significantly to this study, meeting appropriate authorship criteria.

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Correspondence to Brandon C. Chapman.

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Moyer, A.M., Vogel, J.D., Lai, S.H. et al. Total Neoadjuvant Therapy in Rectal Cancer: Multi-center Comparison of Induction Chemotherapy and Long-Course Chemoradiation Versus Short-Course Radiation and Consolidative Chemotherapy. J Gastrointest Surg 27, 980–989 (2023). https://doi.org/10.1007/s11605-023-05601-3

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