TY - JOUR
T1 - Timing to achieve the highest rate of pCR after preoperative radiochemotherapy in rectal cancer: a pooled analysis of 3085 patients from 7 randomized trials
AU - Gambacorta, Maria Antonietta
AU - Masciocchi, Carlotta
AU - Chiloiro, Giuditta
AU - Meldolesi, Elisa
AU - Macchia, Gabriella
AU - Van Soest, Johan
AU - Peters, Fenke
AU - Collette, Laurence
AU - Gérard, Jean-Pierre
AU - Ngan, Samuel
AU - Rödel, C. Claus
AU - Damiani, Andrea
AU - Dekker, Andre
AU - Valentini, Vincenzo
PY - 2021
Y1 - 2021
N2 - Purpose: Optimal timing of surgery after neoadjuvant chemoradiotherapy (Nad-CRT) is still controversial in locally advanced rectal cancer (LARC). The primary goal of this study was to determine the best surgical interval (SI) to achieve the highest rate of pathological complete response (pCR) and secondly to evaluate the effect on survival outcomes according to the SI. Patients and methods: Patients data were extracted from the international randomized trials: Accord12/0405, EORTC22921, FFCD9203, CAO/ARO/AIO-94, CAO-ARO-AIO-04, INTERACT and TROG01.04. Inclusion criteria were: age≥ 18, cT3–T4 and cN0–2, no clinical evidence of distant metastasis at diagnosis, Nad-CRT followed by surgery. Pearson's Chi-squared test with Yates’ continuity correction for categorical variables, the Mann–Whitney test for continuous variables, Mann–Kendall test, Kaplan–Meier curves with log-rank test, univariate and multivariate logistic regression model was used for data analysis. Results: 3085 patients met the inclusion criteria. Overall, the pCR rate was 14% at a median SI of 6 weeks (range 1–31). The cumulative pCR rate increased significantly when SI lengthened, with 95% of pCR events within 10 weeks from Nad-CRT. At univariate and multivariate logistic regression analysis, lengthening of SI (p< 0.01), radiotherapy dose (p< 0.01), and the addition of oxaliplatin to Nad-CRT (p< 0.01) had a favorable impact on pCR. Furthermore, lengthening of SI was not impact on local recurrences, distance metastases, and overall survival. Conclusion: This pooled analysis suggests that the best time to achieve pCR in LARC is at 10 weeks, considering that the lengthening of SI is not detrimental concerning survival outcomes.
AB - Purpose: Optimal timing of surgery after neoadjuvant chemoradiotherapy (Nad-CRT) is still controversial in locally advanced rectal cancer (LARC). The primary goal of this study was to determine the best surgical interval (SI) to achieve the highest rate of pathological complete response (pCR) and secondly to evaluate the effect on survival outcomes according to the SI. Patients and methods: Patients data were extracted from the international randomized trials: Accord12/0405, EORTC22921, FFCD9203, CAO/ARO/AIO-94, CAO-ARO-AIO-04, INTERACT and TROG01.04. Inclusion criteria were: age≥ 18, cT3–T4 and cN0–2, no clinical evidence of distant metastasis at diagnosis, Nad-CRT followed by surgery. Pearson's Chi-squared test with Yates’ continuity correction for categorical variables, the Mann–Whitney test for continuous variables, Mann–Kendall test, Kaplan–Meier curves with log-rank test, univariate and multivariate logistic regression model was used for data analysis. Results: 3085 patients met the inclusion criteria. Overall, the pCR rate was 14% at a median SI of 6 weeks (range 1–31). The cumulative pCR rate increased significantly when SI lengthened, with 95% of pCR events within 10 weeks from Nad-CRT. At univariate and multivariate logistic regression analysis, lengthening of SI (p< 0.01), radiotherapy dose (p< 0.01), and the addition of oxaliplatin to Nad-CRT (p< 0.01) had a favorable impact on pCR. Furthermore, lengthening of SI was not impact on local recurrences, distance metastases, and overall survival. Conclusion: This pooled analysis suggests that the best time to achieve pCR in LARC is at 10 weeks, considering that the lengthening of SI is not detrimental concerning survival outcomes.
KW - Adolescent
KW - Chemoradiotherapy
KW - Humans
KW - Neoadjuvant Therapy
KW - Neoadjuvant radio-chemiotherapy
KW - Neoplasm Recurrence, Local
KW - Neoplasm Staging
KW - Randomized Controlled Trials as Topic
KW - Rectal Neoplasms
KW - Rectal cancer
KW - Surgical interval
KW - Treatment Outcome
KW - pCR
KW - Adolescent
KW - Chemoradiotherapy
KW - Humans
KW - Neoadjuvant Therapy
KW - Neoadjuvant radio-chemiotherapy
KW - Neoplasm Recurrence, Local
KW - Neoplasm Staging
KW - Randomized Controlled Trials as Topic
KW - Rectal Neoplasms
KW - Rectal cancer
KW - Surgical interval
KW - Treatment Outcome
KW - pCR
UR - http://hdl.handle.net/10807/198605
U2 - 10.1016/j.radonc.2020.09.026
DO - 10.1016/j.radonc.2020.09.026
M3 - Article
SN - 0167-8140
VL - 154
SP - 154
EP - 160
JO - Radiotherapy and Oncology
JF - Radiotherapy and Oncology
ER -