Delay to Adjuvant Chemotherapy: Survival and Recurrence in Patients of Rectal Cancer Treated with Neo-adjuvant Chemoradiotherapy and Surgery

Abstract

Purpose

This aim of the study is to evaluate the survival function and hazard risks of delayed adjuvant chemotherapy (ChT) to distant recurrence risk in patients with non-metastatic rectal cancer treated with neoadjuvant chemoradiotherapy (CRT) and surgery.

Methods

A single tertiary hospital retrospective cohort study of a duration of 5 years between January 2012 and December 2016 was performed. As no previous study shown a temporal relationship of delay to adjuvant/systemic ChT leading to increased risk of metastatic disease, we compared between our proposed cut-off with the median and mean value determined by our dataset. Time to event analysis and log rank tests were conducted.

Results

A total of 269 patients with rectal cancer were identified. Two hundred eighteen patients were ineligible, leaving 51 patients for final analysis. Patients in the non-delayed group at 23 (proposed) and 25 (median) weeks’ cut-off reported better 5 years’ disease free survival (DFS) compared with the delayed group by 4.1% and 0.8%. Inversely, at the cut-off 28 (mean) weeks, the delayed group had a better DFS by 4.4%. Females and patients less than 60 years old had better 5-year DFS by 22.8% and 24%. Delayed group has a higher hazard risk ratio (HR) of 1.28 of distant recurrence compared with non-delayed at 23 weeks’ cut-off.

Conclusion

This study has demonstrated delaying a patient to adjuvant ChT will lower their DFS and increase their HR compared with those whose treatment is not delayed. We have long been too focused on local control; hence, priority needs to be shifted to efforts in managing potential distant disease in a timely manner.

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Acknowledgements

Dr. Da Wei Thong would like to acknowledge that this research was undertaken as part of the third year of the MSc in Surgical Sciences or Edinburgh Surgical Sciences Qualification www.essq.rcsed.ac.uk

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Correspondence to Da Wei Thong.

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Thong, D.W., Kim, J., Naik, A. et al. Delay to Adjuvant Chemotherapy: Survival and Recurrence in Patients of Rectal Cancer Treated with Neo-adjuvant Chemoradiotherapy and Surgery. J Gastrointest Canc 51, 877–886 (2020). https://doi.org/10.1007/s12029-019-00312-y

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Keywords

  • Rectal neoplasm
  • Neoadjuvant therapy
  • Neoplasm metastasis
  • Time-to-treatment
  • Treatment delay