Role of adjuvant chemotherapy in ypT0-2N0 patients treated with preoperative chemoradiation therapy and radical resection for rectal cancer

In Ja Park, Dae Yong Kim, Hee Cheol Kim, Nam Kyu Kim, Hyeong Rok Kim, Sung Bum Kang, Gyu Seog Choi, Kang Young Lee, Seon Hahn Kim, Seung Taek Oh, Seok Byung Lim, Jin Cheon Kim, Jae Hwan Oh, Sun Young Kim, Woo Yong Lee, Jung Bok Lee, Chang Sik Yu

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Abstract

Objective To explore the role of adjuvant chemotherapy for patients with ypT0-2N0 rectal cancer treated by preoperative chemoradiation therapy (PCRT) and radical resection. Patients and Methods A national consortium of 10 institutions was formed, and patients with ypT0-2N0 mid- and low-rectal cancer after PCRT and radical resection from 2004 to 2009 were included. Patients were categorized into 2 groups according to receipt of additional adjuvant chemotherapy: Adj CTx (+) versus Adj CTx (-). Propensity scores were calculated and used to perform matched and adjusted analyses comparing relapse-free survival (RFS) between treatment groups while controlling for potential confounding. Results A total of 1016 patients, who met the selection criteria, were evaluated. Of these, 106 (10.4%) did not receive adjuvant chemotherapy. There was no overall improvement in 5-year RFS as a result of adjuvant chemotherapy [91.6% for Adj CTx (+) vs 87.5% for Adj CTx (-), P=.18]. There were no differences in 5-year local recurrence and distant metastasis rate between the 2 groups. In patients who show moderate, minimal, or no regression in tumor regression grade, however, possible association of adjuvant chemotherapy with RFS would be considered (hazard ratio 0.35; 95% confidence interval 0.14-0.88; P=.03). Cox regression analysis after propensity score matching failed to show that addition of adjuvant chemotherapy was associated with improved RFS (hazard ratio 0.81; 95% confidence interval 0.39-1.70; P=.58). Conclusions Adjuvant chemotherapy seemed to not influence the RFS of patients with ypT0-2N0 rectal cancer after PCRT followed by radical resection. Thus, the addition of adjuvant chemotherapy needs to be weighed against its oncologic benefits.

Original languageEnglish
Pages (from-to)540-547
Number of pages8
JournalInternational Journal of Radiation Oncology Biology Physics
Volume92
Issue number3
DOIs
Publication statusPublished - 2015 Jan 1

ASJC Scopus subject areas

  • Radiation
  • Oncology
  • Radiology Nuclear Medicine and imaging
  • Cancer Research

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    Park, I. J., Kim, D. Y., Kim, H. C., Kim, N. K., Kim, H. R., Kang, S. B., Choi, G. S., Lee, K. Y., Kim, S. H., Oh, S. T., Lim, S. B., Kim, J. C., Oh, J. H., Kim, S. Y., Lee, W. Y., Lee, J. B., & Yu, C. S. (2015). Role of adjuvant chemotherapy in ypT0-2N0 patients treated with preoperative chemoradiation therapy and radical resection for rectal cancer. International Journal of Radiation Oncology Biology Physics, 92(3), 540-547. https://doi.org/10.1016/j.ijrobp.2015.02.020