Abstract
Purpose
To investigate the contribution of neoadjuvant chemotherapy in rectal cancer patients with pathological complete response (pCR).
Methods
Data were collected on all consecutive locally advanced rectal cancer patients treated with neoadjuvant chemotherapy and later resected in our institution between 2001 and 2013. Surgery was performed by a single proctology team, and tumor specimens were evaluated by the hospital pathologists.
Results
The medical records of 260 patients were analyzed, and 54 patients of those patients were found to have achieved pCR (20.8 %). Two of those patients were lost to follow-up. Thirty-five of the 54 pCR patients received adjuvant chemotherapy (Group A) and 17 did not (Group B). With the sole exception of the Group A patients being younger than the Group B patients (60.9 ± 11.9 vs. 68.7 ± 10.8 years, respectively, p = 0.0272), all other evaluated parameters were identical between the two groups. There was no advantage for the administration of adjuvant chemotherapy for disease-free survival (DFS) and overall survival (OS).
Conclusions
Adjuvant chemotherapy played no part in disease-free survival and OS of patients with rectal cancer who had been treated with neoadjuvant chemotherapy and achieved pCR. Our findings indicate a tendency for adjuvant chemotherapy to be administered to younger rectal cancer patients. A randomized trial should be conducted to resolve the question of whether they derive any benefit from it.
Similar content being viewed by others
References
Abdul-Jalil KI, Sheehan KM, Kehoe J, Cummins R, O’Grady A, McNamara DA, Deasy J, Breathnach O, Grogan L, O’Neill BD, Faul C, Parker I, Kay EW, Hennessy BT, Gillen P (2014) The prognostic value of tumour regression grade following neoadjuvant chemoradiation therapy for rectal cancer. Colorectal Dis 16:016–025
Agarwal A, Chang GJ, Hu CY, Taggart M, Rashid A, Park IJ, You YN, Das P, Krishnan S, Crane CH, Rodriguez-Bigas M, Skibber J, Ellis L, Eng C, Kopetz S, Maru DM (2013) Quantified pathologic response assessed as residual tumor burden is a predictor of recurrence-free survival in patients with rectal cancer who undergo resection after neoadjuvant chemoradiotherapy. Cancer 119:4231–4241
AJCC colorectal cancer staging, 7th edn. http://www.cancerstaging.org/staging/posters/colon24x30.pdf
Aschele C, Cionini L, Lonardi S, Pinto C, Cordio S, Rosati G, Artale S, Tagliagambe A, Ambrosini G, Rosetti P, Bonetti A, Negru ME, Tronconi MC, Luppi G, Silvano G, Corsi DC, Bochicchio AM, Chiaulon G, Gallo M, Boni L (2011) Primary tumor response to preoperative chemoradiation with or without oxaliplatin in locally advanced rectal cancer: pathologic results of the STAR-01 randomized phase III trial. J Clin Oncol 29:2773–2780
Capirci C, Valentini V, Cionini L, De Paoli A, Rodel C, Glynne-Jones R, Coco C, Romano M, Mantello G, Palazzi S, Mattia FO, Friso ML, Genovesi D, Vidali C, Gambacorta MA, Buffoli A, Lupattelli M, Favretto MS, La Torre G (2008) Prognostic value of pathologic complete response after neoadjuvant therapy in locally advanced rectal cancer: long-term analysis of 566 ypCR patients. Int J Radiat Oncol Biol Phys 72:99–107
Evans J, Tait D, Swift I, Pennert K, Tekkis P, Wotherspoon A, Cunningham D, Brown G (2011) Timing of surgery following preoperative therapy in rectal cancer: the need for a prospective randomized trial? Dis Colon Rectum 54:1251–1259
Glimelius B, Tiret E, Cervantes A, Arnold D, Group EGW (2013) Rectal cancer: ESMO clinical practice guidelines for diagnosis, treatment and follow-up. Ann Oncol 24(Suppl. 6):vi81–vi88
Jemal A, Siegel R, Ward E, Hao Y, Xu J, Murray T, Thun MJ (2008) Cancer statistics, 2008. CA Cancer J Clin 58:71–96
Maas M, Nelemans PJ, Valentini V, Das P, Rödel C, Kuo LJ, Calvo FA, García-Aguilar J, Glynne-Jones R, Haustermans K, Mohiuddin M, Pucciarelli S, Small W Jr, Suárez J, Theodoropoulos G, Biondo S, Beets-Tan RG, Beets GL (2010) Long-term outcome in patients with a pathological complete response after chemoradiation for rectal cancer: a pooled analysis of individual patient data. Lancet Oncol 11:835–844
Rectal cancer, NCCN guidlines, version 3.2014. http://www.nccn.org/professionals/physician_gls/pdf/rectal.pdf
Sauer R, Becker H, Hohenberger W, Rödel C, Wittekind C, Fietkau R, Martus P, Tschmelitsch J, Hager E, Hess CF, Karstens JH, Liersch T, Schmidberger H, Raab R, German Rectal Cancer Study Group (2004) Preoperative versus postoperative chemoradiotherapy for rectal cancer. N Engl J Med 351:1731–1740
Schmoll HJ, Van Cutsem E, Stein A, Valentini V, Glimelius B, Haustermans K, Nordlinger B, van de Velde CJ, Balmana J, Regula J, Nagtegaal ID, Beets-Tan RG, Arnold D, Ciardiello F, Hoff P, Kerr D, Köhne CH, Labianca R, Price T, Scheithauer W, Sobrero A, Tabernero J, Aderka D, Barroso S, Bodoky G, Douillard JY, El Ghazaly H, Gallardo J, Garin A, Glynne-Jones R, Jordan K, Meshcheryakov A, Papamichail D, Pfeiffer P, Souglakos I, Turhal S, Cervantes A (2012) ESMO consensus guidelines for management of patients with colon and rectal cancer. A personalized approach to clinical decision making. Ann Oncol 23:2479–2516
SEER Stat Fact Sheets (1977–2009) Colon and rectum. http://seer.cancer.gov/csr/1975_2009_pops09/results_single/sect_01_table.01.pdf
Sloothaak DA, Geijsen DE, van Leersum NJ, Punt CJ, Buskens CJ, Bemelman WA, Tanis PJ, Dutch Surgical Colorectal Audit (2013) Optimal time interval between neoadjuvant chemoradiotherapy and surgery for rectal cancer. Br J Surg 100:933–939
Tulchinsky H, Shmueli E, Figer A, Klausner JM, Rabau M (2008) An interval >7 weeks between neoadjuvant therapy and surgery improves pathologic complete response and disease-free survival in patients with locally advanced rectal cancer. Ann Surg Oncol 15:2661–2667
Valentini V, van Stiphout RG, Lammering G, Gambacorta MA, Barba MC, Bebenek M, Bonnetain F, Bosset JF, Bujko K, Cionini L, Gerard JP, Rödel C, Sainato A, Sauer R, Minsky BD, Collette L, Lambin P (2011) Nomograms for predicting local recurrence, distant metastases, and overall survival for patients with locally advanced rectal cancer on the basis of European randomized clinical trials. J Clin Oncol 29:3163–3172
Van Cutsem E, Dicato M, Haustermans K, Arber N, Bosset JF, Cunningham D, De Gramont A, Diaz-Rubio E, Ducreux M, Goldberg R, Glynne-Jones R, Haller D, Kang YK, Kerr D, Labianca R, Minsky BD, Moore M, Nordlinger B, Rougier P, Scheithauer W, Schmoll HJ, Sobrero A, Tabernero J, Tempero M, Van de Velde C, Zalcberg J (2007) The diagnosis and management of rectal cancer: expert discussion and recommendations derived from the 9th world congress on gastrointestinal cancer, Barcelona, 2007. Ann Oncol 19(Suppl. 6):vi1–vi8
Acknowledgments
Esther Eshkol, the institutional medical and scientific copyeditor, is thanked for editorial assistance.
Conflict of interest
All authors report no conflicts of interest.
Author information
Authors and Affiliations
Corresponding author
Rights and permissions
About this article
Cite this article
Geva, R., Itzkovich, E., Shamai, S. et al. Is there a role for adjuvant chemotherapy in pathological complete response rectal cancer tumors following neoadjuvant chemoradiotherapy?. J Cancer Res Clin Oncol 140, 1489–1494 (2014). https://doi.org/10.1007/s00432-014-1712-5
Received:
Accepted:
Published:
Issue Date:
DOI: https://doi.org/10.1007/s00432-014-1712-5