Pathe era of oxaliplatin-based adjuvant hological stage N2 rectal cancer patien
PUBLISHED: 2015-11-27  339 total views, 1 today

Yanru Feng1, Jing Jin2, Hua Ren2, Xin Wang2, Shulian Wang2, Weihu Wang2Yongwen Song2, Yueping Liu2, Yuan Tang2, Ning Li2, Xinfan Liu2Hui Fang2, Zihao Yu2, Yexiong Li2

1Department of Radiation Oncology,Cancer Hospital & Institute, Chinese Acadamy of Medical Sciences, Pekingunion   Medical College, 2Chinese Acadamy ofMedical Sciences, Cancer Hospital & Institute

Objective:To evaluate radiochemotherapeutic sequencefor pathological stage N2 rectal cancer in the era of oxaliplatin-basedadjuvant therapy. Method: Treatment outcomes and impact of differentsequence of adjuvant concurrent radiochemotherapy and chemotherapy for stage N2rectal cancer patients after curative surgery were analyzed and compared. Inthe primary adjuvant concurrent chemoradiotherapy (A-CRT) group (N=71),postoperative CRT was administered before adjuvant chemotherapy. In the primaryadjuvant chemotherapy (A-CT) group (N=43), postoperative CRT was administeredduring or after adjuvant chemotherapy. Postoperative radiotherapy consisted of45-50.4 Gy in 25-28 fractions. Concurrent chemotherapy comprised two cycles oforal capecitabine (1,600 mg/m2) on days 1–14 and 22–35. Patientsreceiving adjuvant chemotherapy≥4 cycles of CapeOX or≥8 cycles of FOLFOX wereincluded. Result: Between June 2005 and December 2013, 114 qualifiedrectal cancer patients were analyzed. 33.8% of patients in the A-CRT group and16.3% of patients in the A-CT group developed treatment failure (P=0.042). More patients had distantmetastasis in the A-CRT group compared with those in the A-CT group (32.4% vs.14.3%, P=0.028). No statisticallysignificant difference was observed in 3-year estimated disease-free survivalbetween the primary A-CRT and the A-CT groups. Multivariate analysis indicatedthat radiochemotherapeutic sequence (Primary A-CT vs. Primary A-CRT) wasidentified as an independent prognostic factor for both estimated disease-freesurvival (HR0.345, 95%CI .137-.868, P=0.024)and estimated distant metastases free survival (HR0.366, 95%CI 0.143-0.938, P=0.036). Conclusion: Forpathological stage N2 rectal cancer patients, receiving adjuvant chemotherapybefore chemoradiation showed lower treatment failure, especially distantmetastasis. Adjuvant chemotherapy prescribed as earlier as possible mightbenefit this cohort of patients in the era of oxaliplatin-based adjuvanttherapy.


KeyWords: Adjuvant chemoradiotherapy  Sequence Rectal cancer

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