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Loree, Jonathan M.; Kennecke, Hagen F.; Lee-Ying, Richard M.; Goodwin, Rachel A.; Powell, Erin D.; Tang, Patricia A.; Price Hiller, Julie A.; Vickers, Michael M.; Cheung, Winson Y.

Impact of Postoperative Adjuvant Chemotherapy Following Long-course Chemoradiotherapy in Stage II Rectal Cancer

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  • Medientyp: E-Artikel
  • Titel: Impact of Postoperative Adjuvant Chemotherapy Following Long-course Chemoradiotherapy in Stage II Rectal Cancer
  • Beteiligte: Loree, Jonathan M.; Kennecke, Hagen F.; Lee-Ying, Richard M.; Goodwin, Rachel A.; Powell, Erin D.; Tang, Patricia A.; Price Hiller, Julie A.; Vickers, Michael M.; Cheung, Winson Y.
  • Erschienen: Ovid Technologies (Wolters Kluwer Health), 2018
  • Erschienen in: American Journal of Clinical Oncology
  • Sprache: Englisch
  • DOI: 10.1097/coc.0000000000000342
  • ISSN: 0277-3732
  • Schlagwörter: Cancer Research ; Oncology
  • Entstehung:
  • Anmerkungen:
  • Beschreibung: <jats:sec> <jats:title>Objectives:</jats:title> <jats:p>Use of adjuvant chemotherapy (AC) following neoadjuvant chemoradiation (nCRT) is controversial in rectal cancer (RC). We assessed a multi-institutional database to determine if there was benefit from AC for pathologic stage II RC patients and whether the addition of oxaliplatin to fluoropyrimidine (OXAC) therapy impacted outcomes.</jats:p> </jats:sec> <jats:sec> <jats:title>Materials and Methods:</jats:title> <jats:p>We included patients who underwent nCRT and had pathologic stage II (ypT3/4 ypN0) tumors. Disease-free survival and overall survival were assessed. Multivariate Cox models adjusting for age, sex, Eastern Cooperative Oncology Group, high-risk features (pT4, poor differentiation, &lt;12 nodes removed, lymphovascular/perineural invasion, or obstruction/perforation), and clinical stage were constructed.</jats:p> </jats:sec> <jats:sec> <jats:title>Results:</jats:title> <jats:p>Of 485 patients, 73.6% received AC, of which 25.5% received OXAC. Patients receiving AC were younger (median age 61 vs. 64; <jats:italic toggle="yes">P</jats:italic>=0.003) and had higher rates of total mesorectal excision (81.5% vs. 78.9%; <jats:italic toggle="yes">P</jats:italic>=0.049), but had similar high-risk features, performance status, clinical stage, margin status, preoperative carcinoembryonic antigen, and nCRT regimen. In univariate analysis, overall survival was improved with fluoropyrimidine AC compared with no AC or OXAC (<jats:italic toggle="yes">P</jats:italic>=0.049), but not disease-free survival (<jats:italic toggle="yes">P</jats:italic>=0.33). In multivariate analysis, any AC, fluoropyrimidine AC, or OXAC did not improve outcomes. After stratifying patients by the presence of high-risk features, elevated carcinoembryonic antigen, margin status, or preoperative clinical stage, we did not identify a group with improved outcomes following AC.</jats:p> </jats:sec> <jats:sec> <jats:title>Conclusions:</jats:title> <jats:p>In this multi-institutional cohort of yp stage II RC patients, we failed to identify a group that derives benefit from AC following nCRT. The addition of oxaliplatin did not appear to improve outcomes when compared with fluoropyrimidine alone.</jats:p> </jats:sec>