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The Role of Adjuvant Chemotherapy in ypT0N0 Rectal Adenocarcinoma

  • Anita Nguyen
  • David R. James
  • Eric J. Dozois
  • Scott R. Kelley
  • Kellie L. MathisEmail author
Original Article

Abstract

Background

In patients who develop a complete pathologic response (ypT0N0) following neoadjuvant chemoradiation, the benefits of postoperative chemotherapy remain uncertain. This study aims to determine whether treatment with adjuvant chemotherapy in ypT0N0 patients affects short- and long-term outcomes.

Methods

From January 2000 to December 2015, 992 patients at our institution underwent surgery for rectal adenocarcinoma following treatment with neoadjuvant chemoradiation. A complete pathologic response was noted in 96 (9.7%) patients. Adjuvant chemotherapy was administered to 60 (62.5%) patients. We reviewed clinical and pathological records and compared outcomes in ypT0N0 patients who received adjuvant chemotherapy to those who did not.

Results

The mean age of patients who received adjuvant chemotherapy was 55.6 ± 11.5 years, compared to 62.1 ± 11.7 years for those who did not (p = 0.008). Among the two groups, mean follow-up time after surgery was 5.3 ± 4.1 years for the adjuvant group and 8.3 ± 5.5 years for the non-adjuvant cohort (p = 0.003). The 1, 3, and 5-year survival rates were 100.0%, 97.7%, and 92.1% for patients who received adjuvant chemotherapy and 97.2%, 94.1%, and 90.7% for those who did not (p = 0.382). In a subanalysis of patients with available follow-up information, we observed 3/53 (5.7%) disease recurrences in patients who received adjuvant chemotherapy, compared to 2/18 (11.1%) in those who were not treated postoperatively (p = 0.456).

Conclusion

In patients with ypT0N0 rectal adenocarcinoma, we found equivalent survival and recurrence outcomes. Further study will be necessary to determine the importance of adjuvant chemotherapy following ypT0N0 resection.

Keywords

Rectal adenocarcinoma Pathologic complete response 

Notes

References

  1. 1.
    CDC - Colorectal Cancer Statistics 2018. https://www.cdc.gov/cancer/colorectal/statistics/index.htm. Published March 19, 2018. Accessed March 30, 2018.
  2. 2.
    Bonnetain F, Bosset JF, Gerard JP, et al. What is the clinical benefit of preoperative chemoradiotherapy with 5FU/leucovorin for T3-4 rectal cancer in a pooled analysis of EORTC 22921 and FFCD 9203 trials: surrogacy in question? Eur J Cancer. 2012;48(12):1781–1790.CrossRefGoogle Scholar
  3. 3.
    Bosset J-F, Calais G, Mineur L, et al. Fluorouracil-based adjuvant chemotherapy after preoperative chemoradiotherapy in rectal cancer: long-term results of the EORTC 22921 randomised study. Lancet Oncol. 2014;15(2):184–190.CrossRefGoogle Scholar
  4. 4.
    Du D, Su Z, Wang D, Liu W, Wei Z. Optimal Interval to Surgery After Neoadjuvant Chemoradiotherapy in Rectal Cancer: A Systematic Review and Meta-analysis. Clin Colorectal Cancer. 2018;17(1):13–24.CrossRefGoogle Scholar
  5. 5.
    Lorimer PD, Motz BM, Kirks RC, et al. Pathologic Complete Response Rates After Neoadjuvant Treatment in Rectal Cancer: An Analysis of the National Cancer Database. Ann Surg Oncol. 2017;24(8):2095–2103.CrossRefGoogle Scholar
  6. 6.
    Zorcolo L, Rosman AS, Restivo A, et al. Complete pathologic response after combined modality treatment for rectal cancer and long-term survival: a meta-analysis. Ann Surg Oncol. 2012;19(9):2822–2832.CrossRefGoogle Scholar
  7. 7.
    Maas M, Nelemans PJ, Valentini V, et al. Long-term outcome in patients with a pathological complete response after chemoradiation for rectal cancer: a pooled analysis of individual patient data. Lancet Oncol. 2010;11(9):835–844.CrossRefGoogle Scholar
  8. 8.
    Shahab D, Gabriel E, Attwood K, et al. Adjuvant Chemotherapy Is Associated With Improved Overall Survival in Locally Advanced Rectal Cancer After Achievement of a Pathologic Complete Response to Chemoradiation. Clin Colorectal Cancer. 2017;16(4):300–307.CrossRefGoogle Scholar
  9. 9.
    Geva R, Itzkovich E, Shamai S, et al. Is there a role for adjuvant chemotherapy in pathological complete response rectal cancer tumors following neoadjuvant chemoradiotherapy? J Cancer Res Clin Oncol. 2014;140(9):1489–1494.CrossRefGoogle Scholar
  10. 10.
    Gamaleldin M, Church JM, Stocchi L, Kalady M, Liska D, Gorgun E. Is routine use of adjuvant chemotherapy for rectal cancer with complete pathological response justified? Am J Surg. 2017;213(3):478–483.CrossRefGoogle Scholar
  11. 11.
    Kumar A, Peixoto RD, Kennecke HF, et al. Effect of Adjuvant FOLFOX Chemotherapy Duration on Outcomes of Patients With Stage III Colon Cancer. Clin Colorectal Cancer. 2015;14(4):262–268.e1.CrossRefGoogle Scholar
  12. 12.
    Ludmir EB, Palta M, Willett CG, Czito BG. Total neoadjuvant therapy for rectal cancer: An emerging option. Cancer. 2017;123(9):1497–1506.CrossRefGoogle Scholar
  13. 13.
    Cercek A, Roxburgh CSD, Strombom P, et al. Adoption of Total Neoadjuvant Therapy for Locally Advanced Rectal Cancer. JAMA Oncol. 2018;4(6):e180071.CrossRefGoogle Scholar
  14. 14.
    Wang X, Yu Y, Deng X, et al. Total neoadjuvant treatment (CAPOX plus radiotherapy) for patients with locally advanced rectal cancer with high risk factors: a phase 2 trial. Lancet Oncol. 2017;18:S6.CrossRefGoogle Scholar
  15. 15.
    Wan J-F, Yang L-F, Zhu J, Li G-C, Zhang Z. Adjuvant chemotherapy for patients with ypT0-2N0-category after neoadjuvant chemoradiotherapy for rectal cancer. Mol Clin Oncol. 2017;7(5):864–868.CrossRefPubMedCentralGoogle Scholar
  16. 16.
    Lorenzon L, Parini D, Rega D, et al. Long-term outcomes in ypT0 rectal cancers: An international multi-centric investigation on behalf of Italian Society of Surgical Oncology Young Board (YSICO). Eur J Surg Oncol. 2017;43(8):1472–1480.CrossRefGoogle Scholar
  17. 17.
    Maas M, Beets-Tan RGH, Lambregts DMJ, et al. Wait-and-see policy for clinical complete responders after chemoradiation for rectal cancer. J Clin Oncol. 2011;29(35):4633–4640.CrossRefGoogle Scholar
  18. 18.
    Sherman KL, Wexner SD. Considerations in Stoma Reversal. Clin Colon Rectal Surg. 2017;30(3):172–177.CrossRefPubMedCentralGoogle Scholar

Copyright information

© The Society for Surgery of the Alimentary Tract 2019

Authors and Affiliations

  • Anita Nguyen
    • 1
    • 2
  • David R. James
    • 2
  • Eric J. Dozois
    • 2
  • Scott R. Kelley
    • 2
  • Kellie L. Mathis
    • 2
    Email author
  1. 1.Department of Cardiovascular SurgeryMayo ClinicRochesterUSA
  2. 2.Division of Colon and Rectal SurgeryMayo ClinicRochesterUSA

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