Total neoadjuvant therapy vs standard therapy of locally advanced rectal cancer with high-risk factors for failure
作者机构:Division of RadiologyInstitute of OncologyLjubljana 1000Slovenia Faculty of MedicineUniversity of LjubljanaLjubljana 1000Slovenia Division of SurgeryInstitute of OncologyLjubljana 1000Slovenia Division of RadiotherapyInstitute of OncologyLjubljana 1000Slovenia
出 版 物:《World Journal of Gastrointestinal Oncology》 (世界胃肠肿瘤学杂志(英文版)(电子版))
年 卷 期:2021年第13卷第2期
页 面:119-130页
核心收录:
学科分类:1002[医学-临床医学] 100214[医学-肿瘤学] 10[医学]
主 题:Locally advanced rectal cancer Total neoadjuvant therapy Pathological complete response Neoadjuvant rectal cancer score
摘 要:BACKGROUND For locally advanced rectal cancer(LARC),standard therapy[consisting of neoadjuvant chemoradiotherapy(CRT),surgery,and adjuvant chemotherapy(ChT)]achieves excellent local ***,survival is still poor due to distant metastases,which remains the leading cause of death among these *** recent years,the concept of total neoadjuvant treatment(TNT)has been developed,whereby all systemic ChT-mainly affecting micrometastases-is applied prior to *** To compare standard therapy and total neoadjuvant therapy for LARC patients with high-risk factors for *** In a retrospective study,we compared LARC patients with high-risk factors for failure who were treated with standard therapy or with ***-risk for failure was defined according to the presence of at least one of the following factors:T4 stage;N2 stage;positive mesorectal fascia;extramural vascular invasion;positive lateral lymph *** consisted of 12 wk of induction ChT with capecitabine and oxaliplatin or folinic acid,fluorouracil and oxaliplatin,CRT with capecitabine,and 6-8 wk of consolidation ChT with capecitabine and oxaliplatin or folinic acid,fluorouracil and oxaliplatin prior to *** primary endpoint was pathological complete response(pCR).In total,72 patients treated with standard therapy and 89 patients treated with TNT were included in the *** Compared to standard therapy,TNT showed a higher proportion of pCR(23%vs 7%;P=0.01),a lower neoadjuvant rectal score(median:8.43 vs 14.98;P0.05),higher T-and N-downstaging(70%and 94%vs 51%and 86%),equivalent R0 resection(95%vs 93%),shorter time to stoma closure(mean:20 vs 33 wk;P0.05),higher compliance during systemic ChT(completed all cycles 87%vs 76%;P0.05),lower proportion of acute toxicity grade≥3 during ChT(3%vs 14%,P0.05),and equivalent acute toxicity and compliance during CRT and in the postoperative *** pCR rate in patients treated with TNT was significantly higher in patients