Synapse - Organ preservation after neoadjuvant long-course chemoradiotherapy versus short-course radiotherapy

Organ preservation after neoadjuvant long-course chemoradiotherapy versus short-course radiotherapy Journal Article

Authors:	Bercz, A.; Park, B. K.; Pappou, E.; Nemirovsky, D.; Sarkar, R.; Yamner, M.; Omer, D.; Verheij, F. S.; Alvarez, J.; Atri, P.; Reyngold, M.; Yaeger, R.; Wei, I. H.; Wu, A.; Raj, N.; Widmar, M.; Hajj, C.; Kim, M. J.; Rao, D.; Nash, G. M.; Williams, V.; Shia, J.; Segal, N. H.; Diaz, L.; Ganesh, K.; Weiser, M. R.; Gollub, M. J.; Paty, P. B.; Horvat, N.; Zinovoy, M.; Roth O'Brien, D.; Sanchez-Vega, F.; Saltz, L. B.; Crane, C. H.; Cercek, A.; Gonen, M.; Garcia-Aguilar, J.; Smith, J. J.; Romesser, P. B.
Article Title:	Organ preservation after neoadjuvant long-course chemoradiotherapy versus short-course radiotherapy
Abstract:	Background: Potential differences in organ preservation between total neoadjuvant therapy (TNT) regimens integrating long-course chemoradiotherapy (LCCRT) and short-course radiotherapy (SCRT) in rectal cancer remain undefined. Patients and methods: This natural experiment arose from a policy change in response to the COVID-19 pandemic during which our institution switched from uniformly treating patients with LCCRT to mandating that all patients be treated with SCRT. Our study includes 323 locally advanced rectal adenocarcinoma patients treated with LCCRT-based or SCRT-based TNT from January 2018 to January 2021. Patients who achieved clinical complete response were offered organ preservation with watch-and-wait (WW) management. The primary outcome was 2-year organ preservation. Additional outcomes included local regrowth, distant recurrence, disease-free survival (DFS), and overall survival (OS). Results: Patient and tumor characteristics were similar between LCCRT (n = 247) and SCRT (n = 76) cohorts. Median follow-up was 31 months. Similar clinical complete response rates were observed following LCCRT and SCRT (44.5% versus 43.4%). Two-year organ preservation was 40% [95% confidence interval (CI) 34% to 46%] and 31% (95% CI 22% to 44%) among all patients treated with LCCRT and SCRT, respectively. In patients managed with WW, LCCRT resulted in higher 2-year organ preservation (89% LCCRT, 95% CI 83% to 95% versus 70% SCRT, 95% CI 55% to 90%; P = 0.005) and lower 2-year local regrowth (19% LCCRT, 95% CI 11% to 26% versus 36% SCRT, 95% CI 16% to 52%; P = 0.072) compared with SCRT. The 2-year distant recurrence (10% versus 6%), DFS (90% versus 90%), and OS (99% versus 100%) were similar between WW patients treated with LCCRT and SCRT, respectively. Conclusions: While WW eligibility was similar between cohorts, WW patients treated with LCCRT had higher 2-year organ preservation and lower local regrowth than those treated with SCRT, yet similar DFS and OS. These data support induction LCCRT followed by consolidation chemotherapy as the preferred TNT regimen for patients with locally advanced rectal cancer pursuing organ preservation. © 2024 European Society for Medical Oncology
Keywords:	organ preservation; rectal cancer; short-course radiotherapy; local regrowth; long-course chemoradiotherapy; natural experiment
Journal Title:	Annals of Oncology
Volume:	35
Issue:	11
ISSN:	0923-7534
Publisher:	Oxford University Press
Date Published:	2024-11-01
Start Page:	1003
End Page:	1014
Language:	English
DOI:	10.1016/j.annonc.2024.07.729
PUBMED:	39266364
PROVIDER:	scopus
PMCID:	PMC11513239
DOI/URL:	https://www.scopus.com/inward/record.uri?eid=2-s2.0-85204800857&doi=10.1016%2fj.annonc.2024.07.729&partnerID=40&md5=917d9489b0cac3b4650c9e5707fdbaeb
Notes:	The MSK Cancer Center Support Grant (P30 CA008748) is acknowledge in the PDF -- Corresponding authors is MSK author: Paul B. Romesser -- Source: Scopus