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Revista de investigación clínica
versión On-line ISSN 2564-8896versión impresa ISSN 0034-8376
Resumen
TORRES-OLOMBRADA, María V. de; JUEZ-MARTEL, Ignacio; RODRIGUEZ-CARAVACA, Gil y DURAN-POVEDA, Manuel. Adjuvant Chemotherapy in Locally Advanced Rectal Cancer: Deciding on the Optimal Strategy. Rev. invest. clín. [online]. 2020, vol.72, n.2, pp.88-94. Epub 04-Mayo-2021. ISSN 2564-8896. https://doi.org/10.24875/ric.19003185.
Background:
Neoadjuvant therapy, followed by surgery, reduces the risk of local relapse in rectal cancer, but approximately 30% will relapse with distant metastases, highlighting the importance of adjuvant chemotherapy (aCT).
Objective:
The objective of the study was to study two regimens of adjuvant treatment in patients with locally advanced rectal cancer and analyze their efficacy and toxicity.
Methods:
Between January 2009 and December 2016, 193 patients with Stage II-III rectal cancer who had received neoadjuvant therapy were included by consecutive non-probability sampling. The decision to administer aCT, as well as the specific regimen, was at the discretion of the medical oncologist. Disease-free survival (DFS) and overall survival (OS) were calculated.
Results:
The mean DFS was 84.85 (95% confidence interval [CI]: 79-90) months in 164 patients receiving aCT, compared to 57.71 (95% CI: 40-74) months in 29 who did not receive aCT (p < 0.001). Then, mean OS was 92.7 (95% CI: 88-97) months and 66.18 (95% CI 51-81) months, respectively (p < 0.001). DFS was 83.6 (95% CI: 76-91) months in 74 patients receiving adjuvant 5-fluorouracil (5-FU), and 82.9 (95% CI: 75-90) months in 90 receiving 5-FU plus oxaliplatin (p = 0.49). OS was 87 (95% CI: 80-94) versus 93.65 (95% CI: 88-99) months, respectively (p = 0.76). The multivariate analysis identified aCT hazard ratio (HR) 0.30 (95% CI: 0.1-0.46), perineural invasion HR 3.36 (95% CI: 1.7-6.5), and pathological complete response HR 0.10 (95% CI; 0.01-0.75) as independent markers of DFS.
Conclusions:
In our study, aCT was associated with longer DFS and OS. 5-FU plus oxaliplatin showed greater toxicity with no added benefit in DFS or OS.
Palabras llave : Rectal cancer; Neoadjuvant therapy; Adjuvant chemotherapy; Oxaliplatin; 5-fluorouracil.