Induction chemotherapy reduces patient-reported toxicities during neoadjuvant chemoradiation with intensity modulated radiotherapy for rectal cancer Journal Article


Authors: Ng, S. Y.; Colborn, K. L.; Cambridge, L.; Cercek, A.; Reidy-Lagunes, D. L.; Segal, N.; Stadler, Z.; Saltz, L. B.; Paty, P. B.; Guillem, J.; Weiser, M. R.; Nash, G.; Garcia-Aguilar, J.; Goodman, K. A.
Article Title: Induction chemotherapy reduces patient-reported toxicities during neoadjuvant chemoradiation with intensity modulated radiotherapy for rectal cancer
Abstract: Background: Initial treatment with either neoadjuvant chemoradiation (CRT) or induction FOLFOX (5-Fluorouracil, leucovorin, and oxaliplatin) chemotherapy followed by CRT is considered standard treatment for locally advanced rectal cancer. We compared patient-reported outcomes (PRO) during CRT in patients who had received induction chemotherapy versus those who did not. Patients and Methods: We reviewed records of patients with locally advanced rectal cancer who were treated with CRT between September 2009 and October 2014, and who had completed ≥ 4 PRO assessments during treatment. Clinician- and patient-reported toxicities were collected each week during treatment. We fit binomial generalized linear models to maximum toxicity scores across all patients’ visits. Results: Of 123 patients with ≥ 4 PRO assessments, 87 (71%) patients reported a clinically meaningful PRO score of 3 or higher for diarrhea, and 91 (74%) patients reported a PRO score of ≥ 3 for urgency, during 1 or more weeks of treatment, corresponding to ‘very frequent’ or worse. Of 116 patients who had also completed ≥ 4 clinician-reported assessments for descriptive analysis, clinically significant diarrhea (Common Terminology Criteria for Adverse Events grade ≥ 2) was reported in 9% of patients, and grade 2 proctitis and cystitis were reported in 20% and 4%, respectively. Eighty-four (68%) patients had undergone induction chemotherapy prior to CRT. Patients who received induction chemotherapy had 68% lower odds of experiencing significant urgency (odds ratio [OR], 0.32; 95% confidence interval [CI], 0.11-0.95; P =.04), 76% lower odds of bleeding (OR, 0.24; 95% CI, 0.1-0.62; P <.01), and 75% lower odds of tenesmus (OR, 0.25; 95% CI, 0.11-0.6; P <.01) versus those treated with upfront CRT. Conclusion: Based on PROs, a high proportion of patients experienced clinically significant symptoms during pelvic CRT, with diarrhea and urgency being most commonly reported. This appears to be under-reported on clinician-reported assessments. Delivery of induction chemotherapy was associated with lower odds of experiencing urgency, bleeding, and tenesmus on PROs during subsequent CRT, with no significant impact on diarrhea and rectal pain. © 2019 Elsevier Inc. Based on patient-reported outcomes, a high proportion of patients experienced clinically significant symptoms during pelvic chemoradiotherapy, with diarrhea and urgency being the most commonly reported. Delivery of induction chemotherapy was associated with lower odds of experiencing urgency, bleeding, and tenesmus on patient-reported outcomes during subsequent chemoradiotherapy, with no significant impact on diarrhea and rectal pain. © 2019 Elsevier Inc.
Keywords: patient-reported outcomes; toxicity; chemoradiotherapy; induction chemotherapy; rectal cancer
Journal Title: Clinical Colorectal Cancer
Volume: 18
Issue: 3
ISSN: 1533-0028
Publisher: Elsevier Inc.  
Date Published: 2019-09-01
Start Page: 167
End Page: 174
Language: English
DOI: 10.1016/j.clcc.2019.04.001
PUBMED: 31104990
PROVIDER: scopus
DOI/URL:
Notes: Article -- Export Date: 30 August 2019 -- Source: Scopus
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MSK Authors
  1. Leonard B Saltz
    632 Saltz
  2. Philip B Paty
    387 Paty
  3. Neil Howard Segal
    119 Segal
  4. Jose Guillem
    384 Guillem
  5. Zsofia Kinga Stadler
    170 Stadler
  6. Diane Lauren Reidy
    172 Reidy
  7. Martin R Weiser
    359 Weiser
  8. Garrett Nash
    145 Nash
  9. Shu Yi Ng
    7 Ng