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, Namkyu 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 Jul 1

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chemotherapy
Adjuvant Chemotherapy
Rectal Neoplasms
therapy
cancer
Recurrence
Survival
Propensity Score
Therapeutics
hazards
regression analysis
confidence
Confidence Intervals
intervals
metastasis
Patient Selection
grade
tumors
Regression Analysis
Neoplasm Metastasis

All Science Journal Classification (ASJC) codes

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

Cite this

Park, In Ja ; Kim, Dae Yong ; Kim, Hee Cheol ; Kim, Namkyu ; Kim, Hyeong Rok ; Kang, Sung Bum ; Choi, Gyu Seog ; Lee, Kang Young ; Kim, Seon Hahn ; Oh, Seung Taek ; Lim, Seok Byung ; Kim, Jin Cheon ; Oh, Jae Hwan ; Kim, Sun Young ; Lee, Woo Yong ; Lee, Jung Bok ; Yu, Chang Sik. / Role of adjuvant chemotherapy in ypT0-2N0 patients treated with preoperative chemoradiation therapy and radical resection for rectal cancer. In: International Journal of Radiation Oncology Biology Physics. 2015 ; Vol. 92, No. 3. pp. 540-547.
@article{86b3b43f47a24cd0a4c6d881f2fa29ef,
title = "Role of adjuvant chemotherapy in ypT0-2N0 patients treated with preoperative chemoradiation therapy and radical resection for rectal cancer",
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.",
author = "Park, {In Ja} and Kim, {Dae Yong} and Kim, {Hee Cheol} and Namkyu Kim and Kim, {Hyeong Rok} and Kang, {Sung Bum} and Choi, {Gyu Seog} and Lee, {Kang Young} and Kim, {Seon Hahn} and Oh, {Seung Taek} and Lim, {Seok Byung} and Kim, {Jin Cheon} and Oh, {Jae Hwan} and Kim, {Sun Young} and Lee, {Woo Yong} and Lee, {Jung Bok} and Yu, {Chang Sik}",
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Park, IJ, Kim, DY, Kim, HC, Kim, N, Kim, HR, Kang, SB, Choi, GS, Lee, KY, Kim, SH, Oh, ST, Lim, SB, Kim, JC, Oh, JH, Kim, SY, Lee, WY, Lee, JB & Yu, CS 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, vol. 92, no. 3, pp. 540-547. https://doi.org/10.1016/j.ijrobp.2015.02.020

Role of adjuvant chemotherapy in ypT0-2N0 patients treated with preoperative chemoradiation therapy and radical resection for rectal cancer. / Park, In Ja; Kim, Dae Yong; Kim, Hee Cheol; Kim, Namkyu; Kim, Hyeong Rok; Kang, Sung Bum; Choi, Gyu Seog; Lee, Kang Young; Kim, Seon Hahn; Oh, Seung Taek; Lim, Seok Byung; Kim, Jin Cheon; Oh, Jae Hwan; Kim, Sun Young; Lee, Woo Yong; Lee, Jung Bok; Yu, Chang Sik.

In: International Journal of Radiation Oncology Biology Physics, Vol. 92, No. 3, 01.07.2015, p. 540-547.

Research output: Contribution to journalArticle

TY - JOUR

T1 - Role of adjuvant chemotherapy in ypT0-2N0 patients treated with preoperative chemoradiation therapy and radical resection for rectal cancer

AU - Park, In Ja

AU - Kim, Dae Yong

AU - Kim, Hee Cheol

AU - Kim, Namkyu

AU - Kim, Hyeong Rok

AU - Kang, Sung Bum

AU - Choi, Gyu Seog

AU - Lee, Kang Young

AU - Kim, Seon Hahn

AU - Oh, Seung Taek

AU - Lim, Seok Byung

AU - Kim, Jin Cheon

AU - Oh, Jae Hwan

AU - Kim, Sun Young

AU - Lee, Woo Yong

AU - Lee, Jung Bok

AU - Yu, Chang Sik

PY - 2015/7/1

Y1 - 2015/7/1

N2 - 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.

AB - 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.

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DO - 10.1016/j.ijrobp.2015.02.020

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JO - International Journal of Radiation Oncology Biology Physics

JF - International Journal of Radiation Oncology Biology Physics

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