In a nutshell
This study investigated whether adding mFOLFOX6 (modified; folinic acid, fluorouracil, and oxaliplatin) chemotherapy after standard chemotherapy and radiotherapy (CRT) and delaying surgery improves cancer response and survival in rectal cancer. Researchers suggest that this treatment increases disease-free survival (DFS; patients alive after treatment with no signs of cancer) in these patients.
The standard treatment for patients with locally advanced rectal cancer is chemoradiotherapy (CRT) followed by surgery and chemotherapy after surgery. Despite the effectiveness of this treatment, it is associated with a high rate of complications which affect patients’ quality of life.
Only a limited number of patients (8-24%) achieve a complete response after CRT. Prior studies showed that adding a mFOLFOL6 treatment after CRT increased response rates without increasing after surgery complications. However, DFS and overall survival rates associated with this treatment are not known.
Methods & findings
The DFS and overall survival of 211 patients with advanced rectal cancer were assessed. These patients were divided into 4 groups. Group 1 received CRT and surgery. Group 2 received CRT followed by 2 cycles of mFOLFOX6 and surgery. Group 3 received 4 cycles of mFOLFOX6 after CRT and followed by surgery. Group 4 received 6 cycles of mFOLFOX6 after CRT and followed by surgery. All groups received chemotherapy treatment after surgery.
The average follow-up was 59 months. 58 patients (27.5%) had a complete response (no signs of cancer). The 5-years DFS was significantly higher in groups 2 (81%), 3 (86%) and 4 (76%) compare to group 1 (50%). The 5-years overall survival was also higher in groups 2 (92%), 3 (88%) and 4 (84%) compared to group 1 (79%), but not significantly.
A total of 182 (94%) patients received chemotherapy after surgery. These patients had an improved DFS compared to those who did not receive chemotherapy.
The bottom line
The study concluded that adding mFOLFOX6 chemotherapy after CRT and surgery improves DFS in patients with locally advanced rectal cancer.
The fine print
Information on survival rates was not available for 19% of these patients.
Published By :
Diseases of the colon and rectum
Oct 01, 2018
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