Postoperative chemotherapy after neoadjuvant chemoradiation and surgery for rectal cancer: is it essential for patients with ypT0-2N0?

BACKGROUND: The potential advantage of adjuvant chemotherapy in patients with ypT0-2N0 rectal cancer remains unclear. The purpose of this study was to evaluate whether this therapy has an impact on survival.
MATERIALS AND METHODS: Patients who underwent curative surgery after preoperative chemoradiation for locally advanced low rectal cancer were retrospectively reviewed. A total of 41 consecutive patients with pathological stage 0 (ypT0N0) or I (ypT1-2N0) were enrolled. Of the 41 patients, 17 (41.5%) received postoperative 5-fluorouracil (5-FU)-based chemotherapy, while 24 were followed without postoperative therapy. Oncologic outcomes were compared between the two groups.
RESULTS: The median follow-up period was 47.6 months. The overall postoperative complication rates did not differ significantly between the patients who received chemotherapy and those who did not (17.6% vs. 20.8%, P = 0.799). The 5-year overall and disease-free survival rates for patients who received chemotherapy were 88.9% and 84.7%, which were not significantly different from the rates for those who did not (85.9%; P = 0.644 and 73.4%; P = 0.599, respectively).
CONCLUSIONS: Postoperative adjuvant chemotherapy for patients with good responses after preoperative chemoradiation and curative surgery did not significantly improve the survival. However, this should be validated in prospective randomized trials with larger sample sizes. (c) 2009 Wiley-Liss, Inc.