Adjuvant chemotherapy in rectal cancer: Defining subgroups who may benefit after neoadjuvant chemoradiation and resection: A pooled analysis of 3,313 patients Journal Article

   

Authors:	Maas, M.; Nelemans, P. J.; Valentini, V.; Crane, C. H.; Capirci, C.; Rödel, C.; Nash, G. M.; Kuo, L. J.; Glynne-Jones, R.; Garcia-Aguilar, J.; Suárez, J.; Calvo, F. A.; Pucciarelli, S.; Biondo, S.; Theodoropoulos, G.; Lambregts, D. M. J.; Beets-Tan, R. G. H.; Beets, G. L.
Article Title:	Adjuvant chemotherapy in rectal cancer: Defining subgroups who may benefit after neoadjuvant chemoradiation and resection: A pooled analysis of 3,313 patients
Abstract:	Recent literature suggests that the benefit of adjuvant chemotherapy (aCT) for rectal cancer patients might depend on the response to neoadjuvant chemoradiation (CRT). Aim was to evaluate whether the effect of aCT in rectal cancer is modified by response to CRT and to identify which patients benefit from aCT after CRT, by means of a pooled analysis of individual patient data from 13 datasets. Patients were categorized into three groups: pCR (ypT0N0), ypT1-2 tumour and ypT3-4 tumour. Hazard ratios (HR) for the effect of aCT were derived from multivariable Cox regression analyses. Primary outcome measure was recurrence-free survival (RFS). One thousand seven hundred and twenty three (1723) (52%) of 3,313 included patients received aCT. Eight hundred and ninety eight (898) patients had a pCR, 966 had a ypT1-2 tumour and 1,302 had a ypT3-4 tumour. For 122 patients response, category was missing and 25 patients had ypT0N+. Median follow-up for all patients was 51 (0-219) months. HR for RFS with 95% CI for patients treated with aCT were 1.25(0.68-2.29), 0.58(0.37-0.89) and 0.83(0.66-1.10) for patients with pCR, ypT1-2 and ypT3-4 tumours, respectively. The effect of aCT in rectal cancer patients treated with CRT differs between subgroups. Patients with a pCR after CRT may not benefit from aCT, whereas patients with residual tumour had superior outcomes when aCT was administered. The test for interaction did not reach statistical significance, but the results support further investigation of a more individualized approach to administer aCT after CRT and surgery based on pathologic staging. © 2014 UICC.
Keywords:	survival; adult; controlled study; treatment outcome; treatment response; aged; middle aged; major clinical study; overall survival; fluorouracil; risk benefit analysis; capecitabine; cancer adjuvant therapy; cancer patient; disease free survival; cancer staging; follow up; irinotecan; folinic acid; adjuvant chemotherapy; medical record; response; oxaliplatin; rectum cancer; rectum resection; rectal cancer; recurrence free survival; neoadjuvant treatment; levamisole; adjuvant chemoradiotherapy; human; male; female; priority journal; article
Journal Title:	International Journal of Cancer
Volume:	137
Issue:	1
ISSN:	0020-7136
Publisher:	John Wiley & Sons
Date Published:	2015-07-01
Start Page:	212
End Page:	220
Language:	English
DOI:	10.1002/ijc.29355
PROVIDER:	scopus
PUBMED:	25418551
PMCID:	PMC4957736
DOI/URL:	http://www.scopus.com/inward/record.url?eid=2-s2.0-84930416461&partnerID=40&md5=2efa8807f442d6d556c44c452b5779b3
Notes:	Export Date: 2 July 2015 -- Source: Scopus

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