Improved response rate in patients with prognostically poor locally advanced rectal cancer after treatment with induction chemotherapy and chemoradiotherapy when compared with chemoradiotherapy alone: A matched case-control study |
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| Affiliation: | 1. Department of Surgery, Catharina Hospital, Eindhoven, the Netherlands;2. Department of Medical Oncology, Catharina Hospital, Eindhoven, the Netherlands;3. Department of Radiation Oncology, Catharina Hospital, Eindhoven, the Netherlands;4. Department of Radiology, Catharina Hospital, Eindhoven, the Netherlands;5. Department of Pathology, PAMM Laboratory for Pathology and Medical Microbiology, Eindhoven, the Netherlands;6. GROW School for Oncology and Developmental Biology, Maastricht University, Maastricht, the Netherlands;1. TIMM Laboratory, Sahlgrenska Center for Cancer Research, Department of Infectious Diseases, Institute of Biomedicine, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden;2. Sahlgrenska Center for Cancer Research, Department of Surgery, Institute of Clinical Sciences, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden;3. Wallenberg Centre for Molecular and Translational Medicine, University of Gothenburg, Sweden;4. Department of Surgery, Sahlgrenska University Hospital, Gothenburg, Sweden;1. Division of Thoracic Surgery, Brigham and Women''s Hospital, Boston, MA, USA;2. Department of Thoracic Surgery, The First Affiliated Hospital of Nanjing Medical University, Nanjing, PR China;3. Department of Data Sciences, Dana Farber Cancer Institute, Boston, USA;4. Department of Pathology, Brigham and Women''s Hospital, Boston, MA, USA;1. Department of Surgery, Maisonneuve-Rosemont Hospital, Montreal, QC, Canada;2. Department of Surgery, University of Montreal, Montreal, QC, Canada;3. Department of Gynecology & Obstetrics, University of Montreal, Montreal, QC, Canada |
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| Abstract: | IntroductionThe addition of induction chemotherapy (ICT) to neoadjuvant chemoradiotherapy (CRT) has the potential to improve outcomes in patients with locally advanced rectal cancer (LARC). However, patient selection is essential to prevent overtreatment. This study compared the complete response (CR) rate after treatment with and without ICT of LARC patients with prognostically poor characteristics.MethodsAll LARC patients who were treated with neoadjuvant CRT, whether or not preceded by ICT, and who underwent surgery or were considered for a wait-and-see strategy between January 2016 and March 2020 in the Catharina Hospital Eindhoven, were retrospectively selected. LARC was defined as any T4 tumour, or a T2/T3 tumour with extramural venous invasion and/or tumour deposits and/or N2 lymph node status, and/or mesorectal fascia involvement (T3 tumours only). Case-control matching was performed based on the aforementioned characteristics.ResultsOf 242 patients, 178 (74%) received CRT (CRT-group) and 64 patients (26%) received ICT followed by CRT (ICT-group). In the ICT-group, 3 patients (5%) did not receive the minimum of three cycles. In addition, in this selected cohort, compliance with radiotherapy was 100% in the ICT-group and 97% in the CRT-group. The CR rate was 30% in the ICT-group and 15% in the CRT-group (p = 0.011). After case-control matching, the CR rate was 28% and 9%, respectively (p = 0.013).ConclusionTreatment including ICT seemed well tolerated and resulted in a high CR rate. Hence, this treatment strategy may facilitate organ preservation and improve survival in LARC patients with prognostically poor characteristics. |
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| Keywords: | Locally advanced rectal cancer Induction chemotherapy Chemoradiotherapy Total neoadjuvant therapy Pathological complete response Clinical complete response |
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