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Impact of Postoperative Adjuvant Chemotherapy Following Long-course Chemoradiotherapy in Stage II Rectal Cancer

Loree, Jonathan M., BMSc, MD*; Kennecke, Hagen F., MD, MHA*; Lee-Ying, Richard M., MD; Goodwin, Rachel A., MD, MSc; Powell, Erin D., MD§; Tang, Patricia A., MD; Price Hiller, Julie A., MD; Vickers, Michael M., MD, MPH; Cheung, Winson Y., MD, MPH*

American Journal of Clinical Oncology: July 2018 - Volume 41 - Issue 7 - p 643–648
doi: 10.1097/COC.0000000000000342
Original Articles: Gastrointestinal

Objectives: Use of adjuvant chemotherapy (AC) following neoadjuvant chemoradiation (nCRT) is controversial in rectal cancer (RC). We assessed a multi-institutional database to determine if there was benefit from AC for pathologic stage II RC patients and whether the addition of oxaliplatin to fluoropyrimidine (OXAC) therapy impacted outcomes.

Materials and Methods: We included patients who underwent nCRT and had pathologic stage II (ypT3/4 ypN0) tumors. Disease-free survival and overall survival were assessed. Multivariate Cox models adjusting for age, sex, Eastern Cooperative Oncology Group, high-risk features (pT4, poor differentiation, <12 nodes removed, lymphovascular/perineural invasion, or obstruction/perforation), and clinical stage were constructed.

Results: Of 485 patients, 73.6% received AC, of which 25.5% received OXAC. Patients receiving AC were younger (median age 61 vs. 64; P=0.003) and had higher rates of total mesorectal excision (81.5% vs. 78.9%; P=0.049), but had similar high-risk features, performance status, clinical stage, margin status, preoperative carcinoembryonic antigen, and nCRT regimen. In univariate analysis, overall survival was improved with fluoropyrimidine AC compared with no AC or OXAC (P=0.049), but not disease-free survival (P=0.33). In multivariate analysis, any AC, fluoropyrimidine AC, or OXAC did not improve outcomes. After stratifying patients by the presence of high-risk features, elevated carcinoembryonic antigen, margin status, or preoperative clinical stage, we did not identify a group with improved outcomes following AC.

Conclusions: In this multi-institutional cohort of yp stage II RC patients, we failed to identify a group that derives benefit from AC following nCRT. The addition of oxaliplatin did not appear to improve outcomes when compared with fluoropyrimidine alone.

*Division of Medical Oncology, University of British Columbia, British Columbia Cancer Agency, Vancouver, British Columbia

Division of Medical Oncology, University of Ottawa, The Ottawa Hospital Cancer Center, Ottawa, Ontario

§Division of Medical Oncology, Memorial University, Dr H. Bliss Murphy Cancer Center, St John’s, Newfoundland

Division of Medical Oncology, University of Calgary, Tom Baker Cancer Center, Calgary, Alberta

Division of Medical Oncology, University of Alberta, Cross Cancer Institute, Edmonton, Alberta

The authors declare no conflicts of interest.

Reprints: Winson Y. Cheung, MD, MPH, Division of Medical Oncology, University of British Columbia, British Columbia Cancer Agency, 600 West 10th Avenue, Vancouver, British Columbia, Canada V5Z 4E6. E-mail:

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