Neoadjuvant chemotherapy and radiotherapy followed by resection/ablation in stage IV rectal cancer patients with potentially resectable metastases

BMC Cancer

Bin Zhang¹  Qiaoxuan Wang²  Xiaoxue Huang²  Yuanhong Gao²  Shu Zhang²  Hui Chang²  Zhi Fan Zeng²  Weiwei Xiao²  Chengjing Zhou²  Yan Yuan²  Rongzhen Li²  Weihao Xie²  Shaoqing Niu³  Dongni Chen⁴  Huikai Miao⁴ 

[1] Department of Cardiovascular Surgery, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, 510060, Guangzhou, People’s Republic of China;Department of Radiation Oncology, Sun Yat-Sen University Cancer Center, 510060, Guangzhou, People’s Republic of China;State Key Laboratory of Oncology in South China, Collaborative Innovation Center of Cancer Medicine, 510060, Guangzhou, People’s Republic of China;Department of Radiation Oncology, The First Affiliated Hospital of Sun Yat-sen University, 510060, Guangzhou, People’s Republic of China;State Key Laboratory of Oncology in South China, Collaborative Innovation Center of Cancer Medicine, 510060, Guangzhou, People’s Republic of China;Department of Thoracic Oncology, Sun Yat-Sen University Cancer Center, 510060, Guangzhou, People’s Republic of China;

关键词: Rectal cancer;    Stage IV;    Neoadjuvant chemotherapy;    Radiotherapy;    Local treatment;   

DOI  :  10.1186/s12885-021-09089-5

来源: Springer

【 摘 要 】

BackgroundThe optimal treatment of stage IV rectal cancer remains controversial. The purpose of this study was to assess the treatment outcomes and toxicity of neoadjuvant chemotherapy and radiotherapy followed by local treatment of all tumor sites and subsequent adjuvant chemotherapy in stage IV rectal cancer patients with potentially resectable metastases.MethodsAdult patients diagnosed with locally advanced rectal adenocarcinoma with potentially resectable metastases, who received neoadjuvant chemotherapy and radiotherapy from July 2013 and September 2019 at Sun Yat-sen University cancer center, were included. Completion of the whole treatment schedule, pathological response, treatment-related toxicity and survival were evaluated.ResultsA total of 228 patients were analyzed with a median follow-up of 33 (range 3.3 to 93.4) months. Eventually, 112 (49.1%) patients finished the whole treatment schedule, of which complete response of all tumor sites and pathological downstaging of the rectal tumor were observed in three (2.7%) and 90 (80.4%) patients. The three-year overall survival (OS) and progression-free survival (PFS) of all patients were 56.6% (50.2 to 63.9%) and 38.6% (95% CI 32.5 to 45.8%), respectively. For patients who finished the treatment schedule, 3-year OS (74.4% vs 39.2%, P < 0.001) and 3-year PFS (45.5% vs 30.5%, P = 0.004) were significantly improved compared those who did not finish the treatment. Grade 3–4 chem-radiotherapy treatment toxicities were observed in 51 (22.4%) of all patients and surgical complications occurred in 22 (9.6%) of 142 patients who underwent surgery, respectively.ConclusionsNeoadjuvant chemotherapy and radiotherapy followed by resection/ablation and subsequent adjuvant chemotherapy offered chances of long-term survival with tolerable toxicities for selected patients with potentially resectable stage IV rectal cancer, and could be considered as an option in clinical practice.

【 授权许可】

CC BY