Optimizing Treatment Sequencing of Chemotherapy for Patients with Rectal Cancer: the KIR Randomized Phase II Trial.

CONCLUSION: We confirmed improved compliance to neoadjuvant CT in this study. Although there is no statistical difference in ypT0N0 rate, local recurrence, and DFS between the two arms, a trend towards favourable oncological outcomes is observed. BACKGROUND: In patients with locally advanced rectal cancer, the standard of care consists of preoperative pelvic external beam radiotherapy (EBRT) followed by total mesorectal excision (TME); EBRT either consists of long course chemoradiotherapy (LCRT) with 5-FU/ Capecitabine or short course hypofractionated radiotherapy (SCRT)(1-6). Oxaliplatin in combination with fluoropyrimidine-based chemotherapy (CT) has resulted in improved response rates, progression-free survival (PFS), and overall survival (OS) in metastatic colorectal cancer(7-14) and survival benefit in the adjuvant setting(15, 16). For rectal cancer treatment, adjuvant CT is recommended according to randomized trials including colon and rectal cancers, though there was no strong evidence for the rectal cancer subpopulation. One hypothesis could be related to the low compliance to adjuvant CT in rectal patients after CRT and surgery. Intensification of neoadjuvant CRT failed to demonstrate OS benefit from addition of oxaliplatin to fluoropyrimidine-based CRT, and all(17-20) but the CAOI/ARO/AIO-04 trial(21), reported increased rates of grade 3 and 4 toxicity. Therefore, 5-FU-based CT remains standard with neoadjuvant LCRT and OS unchanged. Thus, the rationale for ...
Source: Radiotherapy and Oncology : journal of the European Society for Therapeutic Radiology and Oncology - Category: Radiology Authors: Tags: Radiother Oncol Source Type: research