Replacing Neoadjuvant CRT with Multiagent Chemo Not Recommended for Rectal Cancer

Replacing Neoadjuvant CRT with Multiagent Chemo Not Recommended for Rectal Cancer
Replacing Neoadjuvant CRT with Multiagent Chemo Not Recommended for Rectal Cancer

The elimination of neoadjuvant chemoradiotherapy in favor of neoadjuvant multiagent chemotherapy was associated with worse overall survival in select patients with stage II and III rectal adenocarcinoma, according to a study published in the journal Cancer.1

Stage II and III rectal cancers can be effectively treated with neoadjuvant chemoradiotherapy followed by definitive resection. Because advancements in surgical technique and systemic therapy have improved outcomes for these patients, researchers sought to compare outcomes after neoadjuvant chemoradiotherapy with those following neoadjuvant multiagent chemotherapy without radiation therapy in select patients with stage II and III rectal adenocarcinoma.

For the study, investigators analyzed data from 21,707 patients with clinical T2N1, T3N0, or T3N1 rectal cancer who had received neoadjuvant chemoradiotherapy or neoadjuvant multiagent chemotherapy followed by low anterior resection between 2004 and 2012.

Results showed that the 5-year overall survival rate was 75% for patients who received radiation vs 67.2% for those who received multiagent chemotherapy (P <.01).

After adjusting for confounding factors, researchers found that those who received chemoradiotherapy had a 23% reduction in the risk of death compared with those who had multiagent chemotherapy (hazard ratio [HR], 0.77; P <.01). In addition, the study showed that age younger than 65 years, having private health insurance, treatment at an academic center, living in an affluent area, a low comorbidity score, receipt of adjuvant chemotherapy, a shorter duration between neoadjuvant therapy and surgery were associated with improved overall survival (P <.05).

In contrast, African Americans, men, patients with high-grade cancers, those with clinical T3N1 tumors, and those who underwent incomplete resection had inferior overall survival (P <.05).

The findings ultimately suggest that neoadjuvant multiagent chemotherapy in place of chemoradiotherapy in this subpopulation should not be recommended outside of a clinical trial.

Reference

1. Cassidy RJ, Liu Y, Patel K, et al. Can we eliminate neoadjuvant chemoradiotherapy in favor of neoadjuvant multiagent chemotherapy for select stage II/III rectal adenocarcinomas: analysis of the National Cancer Database. Cancer. 2016 Oct 25. doi: 10.1002/cncr.30410. [Epub ahead of print]

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