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Neoadjuvant chemotherapy with or without oxaliplatin after short-course radiotherapy in high-risk rectal cancer: A subgroup analysis from a prospective study
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Abstract
Aim
To evaluate the role of oxaliplatin in neoadjuvant chemotherapy delivered after short-course irradiation.
Background
Using oxaliplatin in the above setting is uncertain.
Patients and methods
A subgroup of 136 patients managed by short-course radiotherapy and 3 cycles of consolidation chemotherapy within the framework of a randomised study was included in this post-hoc analysis. Sixty-seven patients received FOLFOX4 (oxaliplatin group) while oxaliplatin was omitted in the second period of accrual in 69 patients because of protocol amendment (fluorouracil-only group).
Results
Grade 3+ acute toxicity from neoadjuvant treatment was observed in 30% of patients in the oxaliplatin group vs. 16% in the fluorouracil-only group (p=0.053). The corresponding proportions of patients having radical surgery or achieving complete pathological response were 72% vs. 77% (odds ratio [OR]=0.88; 95% confidence interval [CI]: 0.39–1.98; p=0.75) and 15% vs. 7% (OR=2.25; 95% CI: 0.83–6.94; p=0.16), respectively. The long-term outcomes were similar in the two groups. Overall and disease-free survival rates at 5 years were 63% vs. 56% (p=0.78) and 49% vs. 44% (p=0.59), respectively. The corresponding numbers for cumulative incidence of local failure or distant metastases were 33% vs. 38% (hazard ratio [HR]=0.89; 95% CI: 0.52–1.52; p=0.68) and 33% vs. 33% (HR=0.78; 95% CI: 0.43–1.40; p=0.41), respectively.
Conclusion
Our findings do not support adding oxaliplatin to three cycles of chemotherapy delivered after short-course irradiation.
Abstract
Aim
To evaluate the role of oxaliplatin in neoadjuvant chemotherapy delivered after short-course irradiation.
Background
Using oxaliplatin in the above setting is uncertain.
Patients and methods
A subgroup of 136 patients managed by short-course radiotherapy and 3 cycles of consolidation chemotherapy within the framework of a randomised study was included in this post-hoc analysis. Sixty-seven patients received FOLFOX4 (oxaliplatin group) while oxaliplatin was omitted in the second period of accrual in 69 patients because of protocol amendment (fluorouracil-only group).
Results
Grade 3+ acute toxicity from neoadjuvant treatment was observed in 30% of patients in the oxaliplatin group vs. 16% in the fluorouracil-only group (p=0.053). The corresponding proportions of patients having radical surgery or achieving complete pathological response were 72% vs. 77% (odds ratio [OR]=0.88; 95% confidence interval [CI]: 0.39–1.98; p=0.75) and 15% vs. 7% (OR=2.25; 95% CI: 0.83–6.94; p=0.16), respectively. The long-term outcomes were similar in the two groups. Overall and disease-free survival rates at 5 years were 63% vs. 56% (p=0.78) and 49% vs. 44% (p=0.59), respectively. The corresponding numbers for cumulative incidence of local failure or distant metastases were 33% vs. 38% (hazard ratio [HR]=0.89; 95% CI: 0.52–1.52; p=0.68) and 33% vs. 33% (HR=0.78; 95% CI: 0.43–1.40; p=0.41), respectively.
Conclusion
Our findings do not support adding oxaliplatin to three cycles of chemotherapy delivered after short-course irradiation.
Keywords
Rectal cancer; Neoadjuvant chemotherapy; Oxaliplatin
About this articleTitle
Neoadjuvant chemotherapy with or without oxaliplatin after short-course radiotherapy in high-risk rectal cancer: A subgroup analysis from a prospective study
Journal
Reports of Practical Oncology and Radiotherapy
Issue
Pages
1017-1022
Published online
2020-11-01
DOI
10.1016/j.rpor.2020.08.002
Bibliographic record
Rep Pract Oncol Radiother 2020;25(6):1017-1022.
Keywords
Rectal cancer
Neoadjuvant chemotherapy
Oxaliplatin
Authors
Ewa Kosakowska
Lucyna Pietrzak
Wojciech Michalski
Lucyna Kepka
Wojciech Polkowski
Malgorzata Jankiewicz
Bogumila Cisel
Jacek Krynski
Jacek Zwolinski
Lucjan Wyrwicz
Andrzej Rutkowski
Roman Stylinski
Grzegorz Nawrocki
Rafal Sopylo
Marek Szczepkowski
Wieslaw Tarnowski
Krzysztof Bujko