Early clinical results from chemoradiation with 5-fluorouracil and oxaliplatin for locally advanced rectal cancer

Impact of interval between preoperative chemotherapy and surgery on therapeutic effects in patients with stage ⅢA and ⅢB rectal cancer

AIM: To assess whether the time interval between neoadjuvant chemoradiotherapy and surgery affects the pathologic complete response (pCR) rate, disease-free survival (DFS), disease recurrence and overall survival (OS) in patients with stage ⅢA and ⅢB rectal cancer.

METHODS: We retrospectively studied 93 patients diagnosed with stage ⅢA and ⅢB rectal cancer by pathological examination who underwent neoadjuvant therapy followed by total mesorectal excision (TME) between March 2009 and March 2011 at our hospital. They were divided into two groups according to the interval between neoadjuvant therapy and surgery: A (≤7 wk, n = 49) and B (>7 wk, n = 44). The primary endpoints were reported as pCR rate, DFS, disease recurrence and OS. Secondary endpoints were type of surgery, postoperative complications, operative time and length of hospital stay.

RESULTS: The overall pCR rate was 10.75% (pCR: group A vs group B, 8.2% vs 13.6%; P = 0.027), and the overall 3-year DFS was 39.8% (DFS: group A vs group B, 28.6% vs 52.3%; P = 0.013). Disease recurrence was 20.4% in group A vs 4.5% in group B (P = 0.023). There were no significant differences in OS, type of surgery, postoperative complications, operative time or length of hospital stay between the two groups.

CONCLUSION: A neoadjuvant-surgery interval > 7 wk increases the rates of pCR and DFS and decreases disease recurrence in patients with stage ⅢA and ⅢB rectal cancer, with no effect on type of surgery, postoperative complications, operative time, length of hospital stay or oncologic outcome.

Impact of interval between neoadjuvant chemoradiotherapy and surgery for rectal cancer on surgical and oncologic outcome

BACKGROUND

The aim of this study was to evaluate the effect of a longer interval between long-course neoadjuvant chemoradiotherapy and surgery on surgical and oncologic outcome.

METHODS

A total of 233 consecutive patients with clinical stage II and III rectal cancer were divided into 2 groups according to the neoadjuvant-surgery interval: short-interval group (≤ 7 weeks, n = 111), and long-interval group (>7 weeks, n = 122). Data on neoadjuvant-surgery interval, operative time, perioperative complications, final pathology, disease recurrence, and mortality were prospectively collected and analyzed.

RESULTS

The two groups were comparable in terms of demographics, tumor, and treatment characteristics. Operative time and perioperative complications were not influenced by a longer interval. Patients in the long-interval group had a significantly higher pathologic complete response (pCR) rate (27.1% vs. 15.3%, P = 0.029), and a decreased rate of circumferential resection margin involvement (1.6% vs. 8.1%, P = 0.020). After a median follow-up of 42 months (range 6-90 months), the 3-year local recurrence rate was 12.9% in the short-interval group versus 4.8% in the long-interval group (P = 0.025).

CONCLUSIONS

A neoadjuvant-surgery interval >7 weeks is safe and is associated with a higher rate of pCR and R0 resection, and decreased local recurrence.

Neoadjuvant therapy for rectal cancer: the impact of longer interval between chemoradiation and surgery

PURPOSE

The aim of this study was to determine the effect of a longer interval between neoadjuvant chemoradiation and surgery on perioperative morbidity and oncologic outcomes.

METHODS

A colorectal cancer database was queried for clinical stage II and III rectal cancer patients undergoing neoadjuvant chemoradiation followed by proctectomy between 1997 and 2007. The neoadjuvant regimen consisted of long course external beam radiation and 5-fluorouracil chemotherapy. Patients with inflammatory bowel disease, hereditary cancer, extracolonic malignancy, urgent surgery, or non-validated treatment dates were excluded. Patients were divided into two groups according to the interval between chemoradiation and surgery (<8 and ≥ 8 weeks). Perioperative complications and oncologic outcomes were compared.

RESULTS

One hundred seventy-seven patients were included. Groups were comparable with respect to demographics, tumor, and treatment characteristics. Perioperative complications were not affected by the interval between chemoradiation and surgery. Patients undergoing surgery ≥ 8 weeks after chemoradiation experienced a significant improvement in pathologic complete response rate (30.8% vs. 16.5%, p = 0.03) and had decreased 3-year local recurrence rate (1.2% vs. 10.5%, p = 0.04). A Cox regression analysis was performed to assess the compounding effect of a complete pathologic response on oncologic outcome. A longer interval correlated with less local recurrence, although statistical significance was not reached (p = 0.07).

CONCLUSION

An interval between chemoradiation and surgery ≥ 8 weeks is safe and is associated with a higher rate of pathologic complete response and decreased local recurrence.