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Onkološki inštitut Ljubljana (OILJ)
  • The value of post-operative chemotherapy after chemoradiotherapy in patients with high-risk locally advanced rectal cancer [Elektronski vir] : results from the RAPIDO trial
    Dijkstra, Esmée A. ...
    Pre-operative chemoradiotherapy (CRT) rather than radiotherapy (RT) has resulted in fewer locoregional recurrences (LRRs), but no decrease in distant metastasis (DM) rate for patients with locally ... advanced rectal cancer (LARC). In many countries, patients receive post-operative chemotherapy (pCT) to improve oncological outcomes. We investigated the value of pCT after pre-operative CRT in the RAPIDO trial. Patients and methods: Patients were randomised between experimental (short-course RT, chemotherapy and surgery) and standard-of-care treatment (CRT, surgery and pCT depending on hospital policy). In this substudy, we compared curatively resected patients from the standard-of-care group who received pCT (pCTþ group) with those who did not (pCT group). Subsequently, patients from the pCTþ group who received at least 75% of the prescribed chemotherapy cycles (pCT 75% group) were compared with patients who did not receive pCT (pCT/ group). By propensity score stratification (PSS), we adjusted for the following unbalanced confounders: age, clinical extramural vascular invasion, distance to the anal verge, ypT stage, ypN stage, residual tumour, serious adverse event (SAE) and/or readmission within 6 weeks after surgery and SAE related to pre-operative CRT. Cumulative probability of disease-free survival (DFS), DM, LRR and overall survival (OS) was analysed by Cox regression. Results: In total, 396/452 patients had a curative resection. The number of patients in the pCTþ, pCT >75%, pCT and pCT/ groups was 184, 112, 154 and 149, respectively. The PSS-adjusted analyses for all endpoints demonstrated hazard ratios between approximately 0.7 and 0.8 (pCTþ versus pCT), and 0.5 and 0.8 (pCT 75% versus pCT/). However, all 95% confidence intervals included 1. Conclusions: These data suggest a benefit of pCT after pre-operative CRT for patients with high-risk LARC, with approximately 20%-25% improvement in DFS and OS and 20%-25% risk reductions in DM and LRR. Compliance with pCT additionally reduces or improves all endpoints by 10%-20%. However, differences are not statistically significant. Key words: locally advanced rectal cancer, post-operative chemotherapy, oncological outcomes, propensity score stratification, adjuvant chemotherapy.
    Vir: ESMO open [Elektronski vir]. - ISSN 2059-7029 (Vol. 8, iss. 2, 2023, str. [1-8])
    Vrsta gradiva - e-članek ; neleposlovje za odrasle
    Leto - 2023
    Jezik - angleški
    COBISS.SI-ID - 156017411

    Povezava(-e):

    https://pubmed.ncbi.nlm.nih.gov/36871393/
    DOI

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