S Dueland1, A H Ree2, K K Grøholt3, M G Saelen4, S Folkvord4, K H Hole5, T Seierstad6, S G Larsen7, K E Giercksky8, J N Wiig7, K Boye9, K Flatmark10. 1. Department of Oncology, Oslo University Hospital - Norwegian Radium Hospital, Oslo, Norway. Electronic address: svedue@ous-hf.no. 2. Department of Oncology, Akershus University Hospital, Akershus, Norway; Institute of Clinical Medicine, University of Oslo, Oslo, Norway. 3. Department of Pathology, Oslo University Hospital - Norwegian Radium Hospital, Oslo, Norway. 4. Department of Tumour Biology, Oslo University Hospital - Norwegian Radium Hospital, Oslo, Norway. 5. Institute of Clinical Medicine, University of Oslo, Oslo, Norway; Department of Radiology & Nuclear Medicine, Oslo University Hospital - Norwegian Radium Hospital, Oslo, Norway. 6. Department of Radiology & Nuclear Medicine, Oslo University Hospital - Norwegian Radium Hospital, Oslo, Norway. 7. Department of Gastroenterological Surgery, Oslo University Hospital - Norwegian Radium Hospital, Oslo, Norway. 8. Institute of Clinical Medicine, University of Oslo, Oslo, Norway; Department of Gastroenterological Surgery, Oslo University Hospital - Norwegian Radium Hospital, Oslo, Norway. 9. Department of Tumour Biology, Oslo University Hospital - Norwegian Radium Hospital, Oslo, Norway; Department of Oncology, Oslo University Hospital - Norwegian Radium Hospital, Oslo, Norway. 10. Department of Gastroenterological Surgery, Oslo University Hospital - Norwegian Radium Hospital, Oslo, Norway; Department of Tumour Biology, Oslo University Hospital - Norwegian Radium Hospital, Oslo, Norway; Institute of Clinical Medicine, University of Oslo, Oslo, Norway.
Abstract
AIMS: This non-randomised study was undertaken to examine oxaliplatin as possibly an intensifying component of sequential neoadjuvant therapy in locally advanced rectal cancer for improved local and metastatic outcome. MATERIALS AND METHODS: Ninety-seven patients (57 T2-3 cases, 40 T4 cases) received two cycles of the Nordic FLOX regimen (oxaliplatin 85 mg/m(2) day 1 and bolus 5-fluorouracil 500 mg/m(2) and folinic acid 100 mg days 1 and 2) before long-course chemoradiotherapy with concomitant oxaliplatin and capecitabine, followed by pelvic surgery. Treatment toxicity, local tumour response and long-term outcome were recorded. RESULTS: Good histologic tumour regression was obtained in 72% of patients. Implementing protocol-specific dose adjustments, tolerance was acceptable and 95% of patients received the total prescribed radiation dose. Estimated 5 year progression-free and overall survival were 61% and 83%, respectively. T4 stage was associated with an inferior local response rate, which again was highly associated with impaired long-term outcome. CONCLUSIONS: In this cohort of rectal cancer patients dominated by T4 and advanced T3 cases given sequential oxaliplatin-containing preoperative therapy with acceptable toxicity, high tumour response rates and overall survival were obtained, consistent with both local and systemic effects. However, tumour response and long-term outcome remained inferior for a significant number of T4 cases, suggesting that the T4 entity is biologically heterogeneous with subgroups of patients eligible for further individualisation of therapy.
AIMS: This non-randomised study was undertaken to examine oxaliplatin as possibly an intensifying component of sequential neoadjuvant therapy in locally advanced rectal cancer for improved local and metastatic outcome. MATERIALS AND METHODS: Ninety-seven patients (57 T2-3 cases, 40 T4 cases) received two cycles of the Nordic FLOX regimen (oxaliplatin 85 mg/m(2) day 1 and bolus 5-fluorouracil 500 mg/m(2) and folinic acid 100 mg days 1 and 2) before long-course chemoradiotherapy with concomitant oxaliplatin and capecitabine, followed by pelvic surgery. Treatment toxicity, local tumour response and long-term outcome were recorded. RESULTS: Good histologic tumour regression was obtained in 72% of patients. Implementing protocol-specific dose adjustments, tolerance was acceptable and 95% of patients received the total prescribed radiation dose. Estimated 5 year progression-free and overall survival were 61% and 83%, respectively. T4 stage was associated with an inferior local response rate, which again was highly associated with impaired long-term outcome. CONCLUSIONS: In this cohort of rectal cancerpatients dominated by T4 and advanced T3 cases given sequential oxaliplatin-containing preoperative therapy with acceptable toxicity, high tumour response rates and overall survival were obtained, consistent with both local and systemic effects. However, tumour response and long-term outcome remained inferior for a significant number of T4 cases, suggesting that the T4 entity is biologically heterogeneous with subgroups of patients eligible for further individualisation of therapy.
Authors: Hanna Abrahamsson; Sebastian Meltzer; Vidar Nyløkken Hagen; Christin Johansen; Paula A Bousquet; Kathrine Røe Redalen; Anne Hansen Ree Journal: BMC Cancer Date: 2021-05-11 Impact factor: 4.430
Authors: Baard-Christian Schem; Frank Pfeffer; Martin Anton Ott; Johan N Wiig; Nils Sletteskog; Torbjørn Frøystein; Mette Pernille Myklebust; Sabine Leh; Olav Dahl; Olav Mella Journal: Cancers (Basel) Date: 2022-01-29 Impact factor: 6.639