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

E. L. K. Voogt*, D. P. Schaap, K. van den Berg, G. A. P. Nieuwenhuijzen, J. G. Bloemen, G. J. Creemers, J. Willems, J. S. Cnossen, H. M. U. Peulen, J. Nederend, G. van Lijnschoten, J. W. A. Burger, H. J. T. Rutten

*Corresponding author for this work

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Abstract

Introduction: The 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. Methods: All 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 per -formed based on the aforementioned characteristics. Results: Of 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). Conclusion: Treatment 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 prog-nostically poor characteristics. (c) 2021 Elsevier Ltd, BASO -The Association for Cancer Surgery, and the European Society of Surgical Oncology. All rights reserved.

Original languageEnglish
Pages (from-to)2429-2435
Number of pages7
JournalEuropean Journal of Surgical Oncology
Volume47
Issue number9
DOIs
Publication statusPublished - Sep 2021

Keywords

  • Locally advanced rectal cancer
  • Induction chemotherapy
  • Chemoradiotherapy
  • Total neoadjuvant therapy
  • Pathological complete response
  • Clinical complete response
  • TOTAL MESORECTAL EXCISION
  • PATHOLOGICAL COMPLETE RESPONSE
  • EXTRAMURAL VASCULAR INVASION
  • DISEASE-FREE SURVIVAL
  • RANDOMIZED PHASE-III
  • NEOADJUVANT CHEMORADIOTHERAPY
  • PREOPERATIVE RADIOTHERAPY
  • FOLLOW-UP
  • SURGERY
  • CHEMORADIATION

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