Which is the best postoperative chemotherapy regimen in patients with rectal cancer after neoadjuvant therapy?

Abstract

BACKGROUND:

There is no general agreement about whether patients who have already received neoadjuvant chemoradiotherapy need further postoperative chemotherapy based on 5-fluorouracil(5-FU) or 5-FU plus oxaliplatin.

METHODS:

Medicare beneficiaries from 1992 to 2008 with Union for International Cancer Control ypStages I to III primary carcinoma of the rectum who underwent 5-FU-based neoadjuvant chemoradiotherapy and surgery for curative intent were identified through the Surveillance, Epidemiology, and End Results (SEER)-Medicare-linked database. A Cox proportional hazards model and propensity score-matched techniques were used to evaluate the effect of treatment on survival.

RESULTS:

For patients with resected rectal cancer who have already received 5-FU-based neoadjuvant chemoradiotherapy, postoperative 5-FU-based chemotherapy did not prolong cancer-specific survival (CSS) in ypStage I (P = 0.960) and ypStage II (P = 0.134); however, it significantly improved the CSS in ypStage III (hazard ratio = 1.547, 95% CI = 1.101-2.173, P = 0.012). No significant differences in survival between the 5-FU group and oxaliplatin group were observed.

CONCLUSIONS:

For patients with resected rectal cancer who have already received 5-FU-based neoadjuvant chemoradiotherapy, postoperative 5-FU-based chemotherapy prolongs the CSS of groups in ypStage III. Adding oxaliplatin to fluoropyrimidines in the postoperative chemotherapy did not improve the CSS for patients who received neoadjuvant chemoradiotherapy.

• Authors: Peng Gao, Yong-xi Song, Jing-xu Sun, Xiao-wan Chen, Ying-ying Xu, Jun-hua Zhao, Xuan-zhang Huang, Hui-mian Xu, Zhen-ning Wang
• Journal: BMC cancer (BMC Cancer) Vol. 14 Pg. 888 (Nov 27 2014) ISSN: 1471-2407 [Electronic] England
• PMID: 25428401 (Publication Type: Journal Article, Research Support, Non-U.S. Gov't)

Topics

• Aged
• Aged, 80 and over
• Antineoplastic Combined Chemotherapy Protocols (therapeutic use)
• Combined Modality Therapy
• Datasets as Topic
• Female
• Humans
• Male
• Neoadjuvant Therapy
• Neoplasm Grading
• Neoplasm Metastasis
• Neoplasm Staging
• Rectal Neoplasms (drug therapy, mortality, pathology, surgery)
• SEER Program
• Treatment Outcome