Risk-Adapted Adjuvant Chemotherapy After Concomitant Fluoropyrimidine–Radiotherapy Neoadjuvant Treatment for Patients With Resectable CT3-4 or N+ Rectal Cancer: Five-Year Disease-Free Survival Results of a Single-Center Series

摘要: Abstract Background Providing adjuvant chemotherapy in locally advanced rectal cancer after neoadjuvant chemoradiation is currently a matter of debate. Recommendations from clinical guidelines range offering no treatment to oxaliplatin-based combinations. We present risk-adapted approach based on the response initial as strongest prognostic factor for disease-free survival (DFS). Patients and Methods One hundred one patients were treated at single institution with preoperative long-course radiotherapy plus concurrent fluoropyrimidines. disease downstaged pT0-2N0 received fluoropyrimidines alone, while remaining an combination. The primary study end point was 5-year DFS. Results Overall, 54 (53.5%), that 47 staged pT3-4 or N+ (46.5%) surgery. In intention-to-treat analysis, DFS good-prognosis group (downstaging pT0-2 N0) those poor prognosis (pT3-4 N+) 79.4% 66.3%, respectively (hazard ratio, 0.489; P  = .043). Downstaging pN+ independent factors Conclusion A therapy strategy pathologic stage feasible achieves high rates good can be thus permitting avoidance oxaliplatin-derived toxicities.