E L K Voogt1, D M G I van Zoggel2, M Kusters3, G A P Nieuwenhuijzen4, J G Bloemen4, H M U Peulen5, G J M Creemers6, G van Lijnschoten7, J Nederend8, M J Roef9, J W A Burger4, H J T Rutten4,10. 1. Department of Surgery, Catharina Hospital, Eindhoven, The Netherlands. eva.voogt@catharinaziekenhuis.nl. 2. Department of Surgery, Isala, Zwolle, The Netherlands. 3. Department of Surgery, Amsterdam University Medical Centres, Location VUmc, Amsterdam, The Netherlands. 4. Department of Surgery, Catharina Hospital, Eindhoven, The Netherlands. 5. Department of Radiotherapy, Catharina Hospital, Eindhoven, The Netherlands. 6. Department of Medical Oncology, Catharina Hospital, Eindhoven, The Netherlands. 7. Pathology Department, PAMM Laboratory for Pathology and Medical Microbiology, Eindhoven, The Netherlands. 8. Department of Radiology, Catharina Hospital, Eindhoven, The Netherlands. 9. Department of Nuclear Medicine, Catharina Hospital, Eindhoven, The Netherlands. 10. GROW School for Oncology and Developmental Biology, Maastricht University, Maastricht, The Netherlands.
Abstract
BACKGROUND: Despite improvements in the multimodality treatment for patients with locally recurrent rectal cancer (LRRC), oncological outcomes remain poor. This study evaluated the effect of induction chemotherapy and subsequent chemo(re)irradiation on the pathologic response and the rate of resections with clear margins (R0 resection) in relation to long-term oncological outcomes. METHODS: All consecutive patients with LRRC treated in the Catharina Hospital Eindhoven who underwent a resection after treatment with induction chemotherapy and subsequent chemo(re)irradiation between January 2010 and December 2018 were retrospectively reviewed. Induction chemotherapy consisted of CAPOX/FOLFOX. Endpoints were pathologic response, resection margin and overall survival (OS), disease free survival (DFS), local recurrence free survival (LRFS), and metastasis free survival (MFS). RESULTS: A pathologic complete response was observed in 22 patients (17%), a "good" response (Mandard 2-3) in 74 patients (56%), and a "poor" response (Mandard 4-5) in 36 patients (27%). An R0 resection was obtained in 83 patients (63%). The degree of pathologic response was linearly correlated with the R0 resection rate (p = 0.026). In patients without synchronous metastases, pathologic response was an independent predictor for LRFS, MFS, and DFS (p = 0.004, p = 0.003, and p = 0.024, respectively), whereas R0 resection was an independent predictor for LRFS and OS (p = 0.020 and p = 0.028, respectively). CONCLUSIONS: Induction chemotherapy in addition to neoadjuvant chemo(re)irradiation is a promising treatment strategy for patients with LRRC with high pathologic response rates that translate into improved oncological outcomes, especially when an R0 resection has been achieved.
BACKGROUND: Despite improvements in the multimodality treatment for patients with locally recurrent rectal cancer (LRRC), oncological outcomes remain poor. This study evaluated the effect of induction chemotherapy and subsequent chemo(re)irradiation on the pathologic response and the rate of resections with clear margins (R0 resection) in relation to long-term oncological outcomes. METHODS: All consecutive patients with LRRC treated in the Catharina Hospital Eindhoven who underwent a resection after treatment with induction chemotherapy and subsequent chemo(re)irradiation between January 2010 and December 2018 were retrospectively reviewed. Induction chemotherapy consisted of CAPOX/FOLFOX. Endpoints were pathologic response, resection margin and overall survival (OS), disease free survival (DFS), local recurrence free survival (LRFS), and metastasis free survival (MFS). RESULTS: A pathologic complete response was observed in 22 patients (17%), a "good" response (Mandard 2-3) in 74 patients (56%), and a "poor" response (Mandard 4-5) in 36 patients (27%). An R0 resection was obtained in 83 patients (63%). The degree of pathologic response was linearly correlated with the R0 resection rate (p = 0.026). In patients without synchronous metastases, pathologic response was an independent predictor for LRFS, MFS, and DFS (p = 0.004, p = 0.003, and p = 0.024, respectively), whereas R0 resection was an independent predictor for LRFS and OS (p = 0.020 and p = 0.028, respectively). CONCLUSIONS: Induction chemotherapy in addition to neoadjuvant chemo(re)irradiation is a promising treatment strategy for patients with LRRC with high pathologic response rates that translate into improved oncological outcomes, especially when an R0 resection has been achieved.
Authors: Esmée A Dijkstra; Véronique E M Mul; Patrick H J Hemmer; Klaas Havenga; Geke A P Hospers; Christina T Muijs; Boudewijn van Etten Journal: Ann Surg Oncol Date: 2021-05-22 Impact factor: 5.344
Authors: Eva L K Voogt; Stefi Nordkamp; Desley M G I van Zoggel; Alette W Daniëls-Gooszen; Grard A P Nieuwenhuijzen; Johanne G Bloemen; Geert-Jan Creemers; Jeltsje S Cnossen; Gesina van Lijnschoten; Jacobus W A Burger; Harm J T Rutten; Joost Nederend Journal: BJS Open Date: 2022-05-02