Nobuki Ichikawa1, Shigenori Homma2, Tohru Funakoshi3, Masahiro Hattori4, Masanori Sato4, You Kamiizumi5, Kazuyoshi Omori6, Masaru Nomura6, Ryoichi Yokota7, Masahiko Koike8, Hirofumi Kon8, Keisa Takeda8, Hiroyuki Ishizu9, Shinichi Matsuoka10, Kunihiro Hirose10, Takahisa Ishikawa11, Ryohei Murata12, Hiroaki Iijima1, Tadashi Yoshida1, Nozomi Minagawa1, Norihiko Takahashi1, Akinobu Taketomi1. 1. Department of Gastroenterological Surgery I, Graduate School of Medicine, Hokkaido University, N-15, W-7, Kita-ku, Sapporo, 060-8638, Japan. 2. Department of Gastroenterological Surgery I, Graduate School of Medicine, Hokkaido University, N-15, W-7, Kita-ku, Sapporo, 060-8638, Japan. homma.s@nifty.com. 3. Department of Surgery, Asahikawa-Kosei General Hospital, 1 jo-dori, 24 choume-111, Asahikawa, 078-8211, Japan. 4. Department of Surgery, Sapporo Hokuyu Hospital, 6 choume 5-1, Higasi-sapporo, Sapporo, 003-0006, Japan. 5. Department of Surgery, Iwamizawa Municipal Hospital, West 7-2, 9 jou, Iwamizawa, 068-8555, Japan. 6. Department of Surgery, Keiwakai Ebetsu Hospita, Yoyogi-cho 81-6, Ebetsu, 069-0817, Japan. 7. Department of Surgery, Sunagawa City Medical Center, W-4, N-3-1-1, Sunagawa, 073-0196, Japan. 8. Department of Surgery, KKR Sapporo Medical Center, Hiragishi 1-6-3-40, Toyohira-ku, Sapporo, 062-0931, Japan. 9. Department of Surgery, Sapporo-Kosei General Hospital, N-3, E-8-5, Chuo-ku, Sapporo, 060-0033, Japan. 10. Department of Surgery, Tomakomai City Hospital, Shimizu-chou 1-5-20, Tomakomai, 053-8567, Japan. 11. Department of Surgery, Abashiri-Kosei General Hospital, N-6, W-1-9, Abashiri, 093-0076, Japan. 12. Department of Surgery, Otaru General Hospital, Wakamatsu-chou 1-1-1, Otaru, 047-8550, Japan.
Abstract
PURPOSE: In this follow-up of the R-NAC-01 study, we assessed the long-term oncological benefit of four courses of modified leucovorin, 5-fluorouracil (FU), and oxaliplatin (mFOLFOX6) chemotherapy before rectal surgery. METHODS: In this prospective, multicenter study (UMIN 000012559) involving 11 hospitals in Japan, patients with lower rectal cancer underwent four cycles of mFOLFOX6 chemotherapy and subsequent surgery within four to six weeks. The 3-year recurrence-free survival and local recurrence rates were then reported. RESULTS: Of 41 patients (36 males, 5 females; mean age: 60.8 years old) who received 4 courses of chemotherapy, 40 underwent total mesorectal excision, and 1 underwent total pelvic exenteration. R0 resection was achieved in 40 patients, but none showed a pathological complete response. Twenty-nine patients received adjuvant chemotherapy for an average of 4 months. The 3 year recurrence-free survival and local recurrence rates in patients undergoing curable resection were 72.8% and 8.5%, respectively. cStage III patients with adjuvant chemotherapy had a significantly higher 3 year recurrence-free survival than those without adjuvant chemotherapy (76.6 vs. 40.0%, log-rank p = 0.03). CONCLUSION: Four courses of mFOLFOX6 chemotherapy before surgery may be a promising treatment strategy for locally advanced rectal cancer. Adjuvant chemotherapy might be needed for cStage III patients, even after four courses of neoadjuvant mFOLFOX6.
PURPOSE: In this follow-up of the R-NAC-01 study, we assessed the long-term oncological benefit of four courses of modified leucovorin, 5-fluorouracil (FU), and oxaliplatin (mFOLFOX6) chemotherapy before rectal surgery. METHODS: In this prospective, multicenter study (UMIN 000012559) involving 11 hospitals in Japan, patients with lower rectal cancer underwent four cycles of mFOLFOX6 chemotherapy and subsequent surgery within four to six weeks. The 3-year recurrence-free survival and local recurrence rates were then reported. RESULTS: Of 41 patients (36 males, 5 females; mean age: 60.8 years old) who received 4 courses of chemotherapy, 40 underwent total mesorectal excision, and 1 underwent total pelvic exenteration. R0 resection was achieved in 40 patients, but none showed a pathological complete response. Twenty-nine patients received adjuvant chemotherapy for an average of 4 months. The 3 year recurrence-free survival and local recurrence rates in patients undergoing curable resection were 72.8% and 8.5%, respectively. cStage III patients with adjuvant chemotherapy had a significantly higher 3 year recurrence-free survival than those without adjuvant chemotherapy (76.6 vs. 40.0%, log-rank p = 0.03). CONCLUSION: Four courses of mFOLFOX6 chemotherapy before surgery may be a promising treatment strategy for locally advanced rectal cancer. Adjuvant chemotherapy might be needed for cStage III patients, even after four courses of neoadjuvant mFOLFOX6.
Authors: Freddie Bray; Jacques Ferlay; Isabelle Soerjomataram; Rebecca L Siegel; Lindsey A Torre; Ahmedin Jemal Journal: CA Cancer J Clin Date: 2018-09-12 Impact factor: 508.702