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The impact of early adjuvant chemotherapy in rectal cancer

 Gyoung Tae Noh  ;  Jeonghee Han  ;  Min Soo Cho  ;  Hyuk Hur  ;  Kang Young Lee  ;  Nam Kyu Kim  ;  Byung Soh Min 
 PLOS ONE, Vol.15(1) : e0228060, 2020-01 
Journal Title
Issue Date
Aged ; Antineoplastic Combined Chemotherapy Protocols / adverse effects* ; Chemotherapy, Adjuvant / methods* ; Disease-Free Survival ; Female ; Humans ; Male ; Middle Aged ; Rectal Neoplasms / drug therapy* ; Retrospective Studies ; Secondary Prevention / methods* ; Treatment Outcome
Purposes: Although adjuvant chemotherapy (AC) has been established as a standard of treatment for advanced rectal cancer, there is no guideline regarding the timing of AC initiation. In this study, we aimed to evaluate the oncologic outcome of early AC initiation and clarify the ideal time to AC among rectal cancer patients receiving preoperative chemo-radiotherapy (preCRT). Methods: The medical records of 719 patients who underwent curative resection followed by AC for rectal cancer were analyzed retrospectively. Data distributions were compared according to the calculated cut-off for AC initiation, survival results, and chemotherapy-induced toxicity. Additionally, patients were divided into two groups according to preCRT status and compared with respect to differences in the optimal time to AC. Results: Overall, a cut-off time point of 20 days after surgery for AC initiation was identified as the optimal interval; this yielded a significant difference in disease-free survival but no significant difference in AC toxicity. In the cut-off analysis of patients treated without preCRT, 19 days was identified as the optimal time to AC. However, for patients treated with preCRT, no significant value affected the survival outcome. Conclusions: Earlier initiation of AC (within approximately 3 weeks) was associated with better oncological outcomes among patients with rectal cancer. Additionally, the optimal timing of AC was unclear among patients who received preCRT; this might be attributable to an undetermined role of AC after preCRT or the effects of complications such as anastomotic leakage.
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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
Min, Byung Soh(민병소) ORCID logo https://orcid.org/0000-0003-0180-8565
Lee, Kang Young(이강영)
Cho, Min Soo(조민수)
Hur, Hyuk(허혁) ORCID logo https://orcid.org/0000-0002-9864-7229
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