Total neoadjuvant therapy in patients with locally advanced rectal cancer: A tertiary medical center experience

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Abstract

The current standard of care for locally advanced rectal cancer (LARC) includes preoperative chemoradiation, followed by total mesorectal excision and adjuvant chemo-therapy. This multimodality treatment improves local control but is associated with low compliance rates without clear bene-ficial effects on overall survival (OS) and distant metastasis. In this retrospective study, the charts of patients diagnosed with cT3/4 or cT2-node-positive rectal cancer between January 2011 and June 2019 were reviewed. The chemoradia-tion therapy (CRT) group received a long course of CRT with capecitabine followed by surgery and adjuvant chemotherapy. The total neoadjuvant therapy (TNT) group received 6 cycles mFOLFOX and a short course of radiation therapy followed by surgery. A total of 81 patients were included, among which 55 (67.9%) received CRT and 26 (32.1%) received TNT. In the CRT group, 15 (27.3%) patients achieved pathologic complete response (pCR) compared with 10 (38.5%) in the TNT group (P=0.22). A total of 19 (35.8%) cases in the CRT group downstaged to pT0N0 or pT1N0 compared with 11 (42.3%) in the TNT group (P=0.33). The 2-year disease-free survival (DFS) rate was 81.0% in the TNT group and 84.0% in the CRT group (P=0.15). Out of 55 patients in the CRT group, 30 patients received adjuvant chemotherapy, 22 (40.0% of CRT cases) of which completed a full course. All 26 patients in the TNT group received neoadjuvant chemotherapy, where 22 (84.6%) patients took a full course (P<0.001). In conclusion, the present study revealed that patients treated with TNT were more compliant to chemotherapy than those treated with CRT. A numerically higher pCR rate, and nodal and tumor down-staging were noted in the TNT group without significance. No difference was noted in the 2-year DFS. Longer follow-up is required.

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APA

El Husseini, Z., Haibe, Y., Bouferraa, Y., Kreidieh, M., Al Darazi, M., Mukherji, D., … Shamseddine, A. (2021). Total neoadjuvant therapy in patients with locally advanced rectal cancer: A tertiary medical center experience. Molecular and Clinical Oncology, 15(4). https://doi.org/10.3892/mco.2021.2382

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