Impact on Loco-regional Control of Radiochemotherapeutic Sequence and Time to Initiation of Adjuvant Treatment in Stage II/III Rectal Cancer Patients Treated with Postoperative Concurrent Radiochemotherapy
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PurposeThis study was designed to evaluate the impact of radiochemotherapeutic sequenceand time to initiation of adjuvant treatment on loco-regional control for resected stageII and III rectal cancer. Materials and MethodsTreatment outcomes for rectal cancer patients from two hospitals with differentsequencing strategies regarding adjuvant concurrent radiochemotherapy (CRCT) werecompared retrospectively. Pelvic radiotherapy was administered concurrently on thefirst (early CRCT, n=180) or the third cycle of chemotherapy (late CRCT, n=180). Duringradiotherapy, two cycles of fluorouracil were provided to patients in both groups. Inthe early CRCT group, median six cycles of fluorouracil and leucovorin were prescribedduring the post-CRCT period. In the late CRCT group, two cycles of fluorouracil wereadministered in the pre- and post-CRCT periods. ResultsNo significant differences in the 5-year loco-regional recurrence-free survival (LRRFS)(92.5% vs. 95.6%, p=0.43) or overall survival and disease-free survival were observedbetween groups. Patients who began receiving adjuvant treatment later than fiveweeks after surgery had lower LRRFS than patients who received adjuvant treatmentwithin five weeks following surgery (79% vs. 91%, p<0.01). The risk of loco-regionalrecurrence increased as the time to initiation of adjuvant treatment was delayed. ConclusionIn the current study, treatment outcomes were not significantly influenced by thesequence of adjuvant treatment but by the delay of adjuvant treatment for more thanfive weeks. Timely administration of adjuvant treatment is deemed important inachieving loco-regional tumor control for stage II/III rectal cancer patients.
Abstract
PurposeThis study was designed to evaluate the impact of radiochemotherapeutic sequenceand time to initiation of adjuvant treatment on loco-regional control for resected stageII and III rectal cancer. Materials and MethodsTreatment outcomes for rectal cancer patients from two hospitals with differentsequencing strategies regarding adjuvant concurrent radiochemotherapy (CRCT) werecompared retrospectively. Pelvic radiotherapy was administered concurrently on thefirst (early CRCT, n=180) or the third cycle of chemotherapy (late CRCT, n=180). Duringradiotherapy, two cycles of fluorouracil were provided to patients in both groups. Inthe early CRCT group, median six cycles of fluorouracil and leucovorin were prescribedduring the post-CRCT period. In the late CRCT group, two cycles of fluorouracil wereadministered in the pre- and post-CRCT periods. ResultsNo significant differences in the 5-year loco-regional recurrence-free survival (LRRFS)(92.5% vs. 95.6%, p=0.43) or overall survival and disease-free survival were observedbetween groups. Patients who began receiving adjuvant treatment later than fiveweeks after surgery had lower LRRFS than patients who received adjuvant treatmentwithin five weeks following surgery (79% vs. 91%, p<0.01). The risk of loco-regionalrecurrence increased as the time to initiation of adjuvant treatment was delayed. ConclusionIn the current study, treatment outcomes were not significantly influenced by thesequence of adjuvant treatment but by the delay of adjuvant treatment for more thanfive weeks. Timely administration of adjuvant treatment is deemed important inachieving loco-regional tumor control for stage II/III rectal cancer patients.
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