Therapeutic effects of oxaliplatin-based neoadjuvant chemotherapy and chemoradiotherapy in patients with locally advanced rectal cancer: a single-center, retrospective cohort study

• Published in: World journal of surgical oncology Vol. 16; no. 1; pp. 105 - 8
• Main Authors: Okuyama, Takashi, Sameshima, Shinichi, Takeshita, Emiko, Yoshioka, Ryuji, Yamagata, Yukinori, Ono, Yuko, Tagaya, Nobumi, Noie, Tamaki, Oya, Masatoshi
• Format: Journal Article
• Language: English
• Published: England BioMed Central Ltd 05-06-2018; BioMed Central; BMC
• Subjects: 5-Fluorouracil; Adult; Aged; Antineoplastic Combined Chemotherapy Protocols - administration & dosage; Antineoplastic Combined Chemotherapy Protocols - therapeutic use; Biopsy; Cancer; Cancer therapies; Chemoradiotherapy; Chemoradiotherapy - methods; Chemoradiotherapy, Adjuvant; Chemotherapy; Chemotherapy, Adjuvant; Cohort analysis; Colorectal cancer; Combined Modality Therapy; Diagnosis; Diarrhea; Disease-Free Survival; Dosage and administration; Feasibility studies; Female; Fluorouracil - administration & dosage; Gangrene; Humans; Laparoscopy; Locally advanced rectal cancer; Lymph nodes; Lymphatic system; Male; Metastasis; Middle Aged; Mutation; Neoadjuvant chemoradiotherapy; Neoadjuvant Therapy; Neoplasm Recurrence, Local - prevention & control; Neoplasm Staging; Neutropenia; NMR; Nuclear magnetic resonance; Oxaliplatin; Oxaliplatin - administration & dosage; Oxaliplatin - therapeutic use; Oxaliplatin-based neoadjuvant chemotherapy; Patients; Prognosis; Radiation therapy; Radiotherapy; Rectal Neoplasms - drug therapy; Rectal Neoplasms - pathology; Rectal Neoplasms - surgery; Rectum; Relapse-free survival; Retrospective Studies; Surgeons; Surgery; Survival; Systematic review; Treatment Outcome; Tumors; Locally advanced rectal cancer; Oxaliplatin-based neoadjuvant chemotherapy; Neoadjuvant chemoradiotherapy; Relapse-free survival
• ISSN: 1477-7819; 1477-7819
• DOI: 10.1186/s12957-018-1403-9

Neoadjuvant chemoradiotherapy (NACRT) has now become the standard treatment for locally advanced rectal cancer (LARC). NACRT has decreased local relapse (LR) rate in patients with LARC; however, distant relapse has recently attracted much attention. This study aimed to assess the feasibility and efficiency of neoadjuvant chemotherapy (NAC) for LARC.
Data on patients with cT3/4 and N+ rectal cancer who were treated in our institution from April 2010 to February 2016 were reviewed retrospectively. Twenty-seven patients who received 2-9 cycles of oxaliplatin-based NAC and 28 patients who received NACRT (45 Gy delivered in 25 fractions and 5-fluorouracil-based oral chemotherapy) were analyzed. The primary and secondary endpoints of the present study were the 3-year relapse-free survival (RFS) and the local and distant relapse rates, respectively.
Regardless of the kind of neoadjuvant therapy, no patient experienced any grade 3-4 therapy-related adverse events. The frequent toxic events were grade 1 diarrhea in patients with NACRT and neutropenia in patients with NAC. A significantly higher proportion of patients with NAC underwent laparoscopic surgery and anterior resection (p = 0.037 and p = 0.003, respectively). The percentages of patients with lymph node yield less than 12 in the NAC group, and those in the NACRT group were 26 and 68%, respectively (p = 0.002). Comparing the NAC with the NACRT groups, the local relapse and distant relapse rates were 7.4 and 7.1% and 7.4 and 18%, respectively. There were no significant differences in 3-year RFS and 4-year overall survival (OS) between NAC and NACRT (3-year RFS 85.2 vs. 70.4%, p = 0.279; 4-year OS 96.3 vs. 89.1%, p = 0.145, respectively). With an analysis excluding patients who received postoperative adjuvant chemotherapy, no patients who received NAC had a distant relapse, and there was a significant difference in 3-year RFS compared with the NACRT groups (94.4 vs. 63.2%, p = 0.043).
These outcomes suggest that the therapeutic effect of oxaliplatin-based NAC is at least equal to that of NACRT and that NAC is a feasible and promising option for LARC.