Review of Neoadjuvant Chemotherapy Alone in Locally Advanced Rectal Cancer

被引：15

作者：

Jalil O. ^{[1
,2
]}

Claydon L. ^{[3
]}

Arulampalam T. ^{[1
]}

机构：

[1] Department of General and Colorectal Surgery, Colchester Hospital University, Turner Road, Colchester

[2] Gloucestershire Royal Hospital, Gloucester

[3] Anglia Ruskin University, Bishop Hall lane, Chelmsford, Essex

来源：

Journal of Gastrointestinal Cancer | 2015年 / 46卷 / 3期

关键词：

Combined modality therapy; Drug therapy; Preoperative care neoadjuvant therapy; Preoperative period; Rectal neoplasm;

D O I：

10.1007/s12029-015-9739-7

中图分类号：

学科分类号：

摘要：

Background: Currently, the standard management of locally advanced rectal cancer (LARC) is neoadjuvant chemoradiotherapy followed by resection. Despite the significant improvement in local recurrence, survival benefits are not gained due to distant failure and radiotherapy-associated toxicity. Compliance to adjuvant chemotherapy after preoperative chemoradiotherapy is also poor. Neoadjuvant chemotherapy alone followed by surgery may be an alternative. The objective of this review is to determine the efficacy of neoadjuvant chemotherapy alone in operable LARC. Materials and Methods: Electronic databases searched (from database inception–December 2013) were Medline, PubMed, Embase, Scopus, Cochrane library, and the Clinical Trials Register. Specific journals were also hand searched. The selection criteria were studies published in English investigating stage II–III non-metastatic rectal cancer patients treated with neoadjuvant chemotherapy (oral, intravenous or rectal route) followed by curative resection. The primary outcome measure was tumour response. Secondary outcome measures included acute toxicity, operative morbidity, R0 resection, local recurrence, overall survival (OS) and disease-free survival (DFS). Results: One randomised phase III trial, six single-arm phase II trials and one retrospective case series study were eligible for inclusion. Six studies administered fluoropyrimidine-based multiple agent regimens and two studies administered fluorouracil-based monotherapy. The studies with multiple agents and stronger chemotherapy regimens (intravenous and/or oral) followed by delayed surgery showed better tumour response rates. The overall objective response rate was good and ranged from 62.5 to 93.7 %. Pathological complete response ranged from 3.8 to 33.3 %. The R0 resection and compliance rates were also high ranging from 90 to 100 % and 72 to 100 %, respectively. Grade 3–4 toxicities ranged from 2.3 to 39 %. Four- to 5-year OS and DFS ranged from 67.2 to 91 % and 60.5 to 84 %, respectively. Conclusion: This review demonstrates that neoadjuvant chemotherapy could be affectively administered in LARC and could provide a good alternative to chemoradiotherapy in moderate-risk rectal cancers without compromising short- and long-term outcomes. © 2015, Springer Science+Business Media New York.

引用

页码：219 / 236

页数：17

共 39 条

[1]

Ferlay J., Shin H.R., Bray F., Forman D., Mathers C., Parkin D.M., GLOBOCAN 2008 v2.0, Cancer incidence and mortality worldwide: IARC Cancer Base No, (2010)

[2]

Sauer R., Becker H., Hohenberger W., Rodel C., Wittekind C., Fietkau R., Et al., Preoperative versus postoperative chemoradiotherapy for rectal cancer, N Engl J Med, 351, 17, pp. 1731-1740, (2004)

[3]

Bujko K., Nowacki M., Nasierowska-Guttmejer A., Michalski W., Bebenek M., Kryj M., Long-term results of a randomised trial comparing preoperative short-course radiotherapy with preoperative conventionally fractionated chemoradiation for rectal cancer, Br J Surg, 93, pp. 1215-1223, (2006)

[4]

Gerard J.P., Conroy T., Bonnetain F., Bouche O., Chapet O., Closon-Dejardin M., Et al., Preoperative radiotherapy with or without concurrent fluorouracil and leucovorin in T3–4 rectal cancers: results of FFCD 9203, J Clin Oncol, 24, 28, pp. 4620-4625, (2006)

[5]

Bosset J., Collette L., Calais G., Mineur L., Maingon P., Radosevic-Jelic L., Et al., Chemotherapy with preoperative radiotherapy in rectal cancer. EORTC Radiotherapy Group Trial 22921, N Engl J Med, 14, 355, pp. 1114-1123, (2006)

[6]

Kapiteijn E., Marijnen C., Nagtegaal I., Putter H., Steup W., Wiggers T., Et al., Preoperative radiotherapy combined with total mesorectal excision for resectable rectal cancer, N Engl J Med, 345, 9, pp. 638-646, (2001)

[7]

Marijnen C., van de Velde C., Putter H., van den Brink M., Maas C., Martijn H., Et al., Impact of short-term preoperative radiotherapy on health-related quality of life and sexual functioning in primary rectal cancer: report of a multicenter randomized trial, J Clin Oncol, 23, 9, pp. 1847-1858, (2005)

[8]

Seymour M.T., Ferry D.R., Meade A.M., Thompson L., Griffiths G.O., Parmar M.K., Et al., Different strategies of sequential and combination chemotherapy for patients with poor prognosis advanced colorectal cancer (MRC FOCUS): a randomised controlled trial, Lancet, 370, 9582, pp. 143-152, (2007)

[9]

de Gramont A., Figer A., Seymour M., Homerin M., Hmissi A., Cassidy J., Et al., Leucovorin and fluorouracil with or without oxaliplatin as first line treatment in advanced colorectal cancer, J Clin Oncol, 18, 16, pp. 2938-2947, (2000)

[10]

Ribero D., Wang H., Donadon M., Zorzi D., Thomas M.B., Eng C., Et al., Bevacizumab improves pathologic response and protects against hepatic injury in patients treated with oxaliplatin‐based chemotherapy for colorectal liver metastases, Cancer, 110, 12, pp. 2761-2767, (2007)

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