Adjuvant chemotherapy in locally advanced rectal cancer: deciding on the optimal strategy
Rev. invest. clín
; 72(2): 88-94, Mar.-Apr. 2020. tab, graf
Article
in En
| LILACS
| ID: biblio-1251839
Responsible library:
BR1.1
ABSTRACT
ABSTRACT Background:
Neoadjuvant therapy, followed by surgery, reduces the risk of local relapse in rectal cancer, but approximately 30% will relapse with distant metastases, highlighting the importance of adjuvant chemotherapy (aCT).Objective:
The objective of the study was to study two regimens of adjuvant treatment in patients with locally advanced rectal cancer and analyze their efficacy and toxicity.Methods:
Between January 2009 and December 2016, 193 patients with Stage II-III rectal cancer who had received neoadjuvant therapy were included by consecutive non-probability sampling. The decision to administer aCT, as well as the specific regimen, was at the discretion of the medical oncologist. Disease-free survival (DFS) and overall survival (OS) were calculated.Results:
The mean DFS was 84.85 (95% confidence interval [CI] 79-90) months in 164 patients receiving aCT, compared to 57.71 (95% CI 40-74) months in 29 who did not receive aCT (p < 0.001). Then, mean OS was 92.7 (95% CI 88-97) months and 66.18 (95% CI 51-81) months, respectively (p < 0.001). DFS was 83.6 (95% CI 76-91) months in 74 patients receiving adjuvant 5-fluorouracil (5-FU), and 82.9 (95% CI 75-90) months in 90 receiving 5-FU plus oxaliplatin (p = 0.49). OS was 87 (95% CI 80-94) versus 93.65 (95% CI 88-99) months, respectively (p = 0.76). The multivariate analysis identified aCT hazard ratio (HR) 0.30 (95% CI 0.1-0.46), perineural invasion HR 3.36 (95% CI 1.7-6.5), and pathological complete response HR 0.10 (95% CI; 0.01-0.75) as independent markers of DFS.Conclusions:
In our study, aCT was associated with longer DFS and OS. 5-FU plus oxaliplatin showed greater toxicity with no added benefit in DFS or OS.Key words
Full text:
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Index:
LILACS
Main subject:
Rectal Neoplasms
/
Chemotherapy, Adjuvant
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Fluorouracil
/
Oxaliplatin
/
Antineoplastic Agents
Type of study:
Observational_studies
/
Prognostic_studies
/
Risk_factors_studies
Limits:
Adult
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Aged
/
Aged80
/
Female
/
Humans
/
Male
Language:
En
Journal:
Rev. invest. clín
Journal subject:
MEDICINA
Year:
2020
Type:
Article