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Role of Adjuvant Chemotherapy in ypT0-2N0 Patients Treated with Preoperative Chemoradiation Therapy and Radical Resection for Rectal Cancer

Authors
 In Ja Park  ;  Dae Yong Kim  ;  Hee Cheol Kim  ;  Nam Kyu Kim  ;  Hyeong-Rok Kim  ;  Sung-Bum Kang  ;  Gyu-Seog Choi  ;  Kang Young Lee  ;  Seon-Hahn Kim  ;  Seung Taek Oh  ;  Seok-Byung Lim  ;  Jin Cheon Kim  ;  Jae Hwan Oh  ;  Sun Young Kim  ;  Woo Yong Lee  ;  Jung Bok Lee  ;  Chang Sik Yu 
Citation
 International Journal of Radiation Oncology Biology Physics, Vol.92(3) : 540-547, 2015 
Journal Title
 International Journal of Radiation Oncology Biology Physics 
ISSN
 0360-3016 
Issue Date
2015
MeSH
Adenocarcinoma/mortality ; Adenocarcinoma/pathology* ; Adenocarcinoma/secondary ; Adenocarcinoma/surgery ; Adenocarcinoma/therapy* ; Aged ; Anal Canal ; Antineoplastic Combined Chemotherapy Protocols/therapeutic use* ; Capecitabine ; Chemoradiotherapy, Adjuvant* ; Chemotherapy, Adjuvant ; Confidence Intervals ; Deoxycytidine/administration & dosage ; Deoxycytidine/analogs & derivatives ; Disease-Free Survival ; Female ; Fluorouracil/administration & dosage ; Fluorouracil/analogs & derivatives ; Humans ; Male ; Middle Aged ; Neoplasm Recurrence, Local ; Organ Sparing Treatments ; Preoperative Care ; Propensity Score ; Radiotherapy Dosage ; Rectal Neoplasms/mortality ; Rectal Neoplasms/pathology* ; Rectal Neoplasms/surgery ; Rectal Neoplasms/therapy* ; Regression Analysis ; Treatment Outcome
Abstract
OBJECTIVE: To explore the role of adjuvant chemotherapy for patients with ypT0-2N0 rectal cancer treated by preoperative chemoradiation therapy (PCRT) and radical resection. PATIENTS AND METHODS: A national consortium of 10 institutions was formed, and patients with ypT0-2N0 mid- and low-rectal cancer after PCRT and radical resection from 2004 to 2009 were included. Patients were categorized into 2 groups according to receipt of additional adjuvant chemotherapy: Adj CTx (+) versus Adj CTx (-). Propensity scores were calculated and used to perform matched and adjusted analyses comparing relapse-free survival (RFS) between treatment groups while controlling for potential confounding. RESULTS: A total of 1016 patients, who met the selection criteria, were evaluated. Of these, 106 (10.4%) did not receive adjuvant chemotherapy. There was no overall improvement in 5-year RFS as a result of adjuvant chemotherapy [91.6% for Adj CTx (+) vs 87.5% for Adj CTx (-), P=.18]. There were no differences in 5-year local recurrence and distant metastasis rate between the 2 groups. In patients who show moderate, minimal, or no regression in tumor regression grade, however, possible association of adjuvant chemotherapy with RFS would be considered (hazard ratio 0.35; 95% confidence interval 0.14-0.88; P=.03). Cox regression analysis after propensity score matching failed to show that addition of adjuvant chemotherapy was associated with improved RFS (hazard ratio 0.81; 95% confidence interval 0.39-1.70; P=.58). CONCLUSIONS: Adjuvant chemotherapy seemed to not influence the RFS of patients with ypT0-2N0 rectal cancer after PCRT followed by radical resection. Thus, the addition of adjuvant chemotherapy needs to be weighed against its oncologic benefits.
Full Text
https://www.sciencedirect.com/science/article/pii/S0360301615001984
DOI
10.1016/j.ijrobp.2015.02.020
Appears in Collections:
1. College of Medicine (의과대학) > Dept. of Surgery (외과학교실) > 1. Journal Papers
Yonsei Authors
Kim, Nam Kyu(김남규) ORCID logo https://orcid.org/0000-0003-0639-5632
URI
https://ir.ymlib.yonsei.ac.kr/handle/22282913/165603
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