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The value of post-o...
The value of post-operative chemotherapy after chemoradiotherapy in patients with high-risk locally advanced rectal cancerdresults from the RAPIDO trial
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- Dijkstra, E. A. (författare)
- Univ Groningen, Univ Med Ctr Groningen, Dept Med Oncol, Hanzepl 1,Postbus 30-001, NL-9700 RB Groningen, Netherlands.
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- Zwart, W. H. (författare)
- Univ Groningen, Univ Med Ctr Groningen, Dept Med Oncol, Hanzepl 1,Postbus 30-001, NL-9700 RB Groningen, Netherlands.
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- Nilsson, P. J. (författare)
- Karolinska Institutet
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- Putter, H. (författare)
- Leiden Univ, Dept Med Stat & Bioinformat, Med Ctr, Leiden, Netherlands.
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- Roodvoets, A. G. H. (författare)
- Leiden Univ, Dept Surg, Med Ctr, Leiden, Netherlands.
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- Kranenbarg, E. Meershoek-Klein (författare)
- Leiden Univ, Dept Surg, Med Ctr, Leiden, Netherlands.
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- Froedin, J. E. (författare)
- Karolinska Univ Hosp, Dept Oncol Pathol, Stockholm, Sweden.
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- Nygren, Peter (författare)
- Uppsala universitet,Cancerfarmakologi och beräkningsmedicin,Science for Life Laboratory, SciLifeLab,Cancerprecisionsmedicin
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- ostergaard, L. (författare)
- Aalborg Univ Hosp, Dept Clin Med, Aalborg, Denmark.
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- Kersten, C. (författare)
- Sorlandet Hosp Trust, Dept Res, Kristiansand, Norway.
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- Verbiene, I. (författare)
- Uppsala universitet,Institutionen för immunologi, genetik och patologi
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- Cervantes, A. (författare)
- Univ Valencia, Biomed Res Inst Incliva, Dept Med Oncol, Valencia, Spain.
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- Hendriks, M. P. (författare)
- Northwest Clin, Dept Med Oncol, Alkmaar, Netherlands.
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- Capdevila, J. (författare)
- Autonomous Univ Barcelona UAB, Vall Hebron Univ Hosp, Vall Hebron Inst Oncol VHIO, Dept Med Oncol, Barcelona, Spain.
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- Edhemovic, I. (författare)
- Inst Oncol Ljubljana, Dept Surg Oncol, Ljubljana, Slovenia.
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- van de Velde, C. J. H. (författare)
- Leiden Univ, Dept Surg, Med Ctr, Leiden, Netherlands.
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- Marijnen, C. A. M. (författare)
- Netherlands Canc Inst, Dept Radiat Oncol, Amsterdam, Netherlands.;Leiden Univ, Dept Radiat Oncol, Med Ctr, Leiden, Netherlands.
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- van Etten, B. (författare)
- Univ Groningen, Univ Med Ctr Groningen, Dept Surg, Groningen, Netherlands.
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- Hospers, G. A. P. (författare)
- Univ Groningen, Univ Med Ctr Groningen, Dept Med Oncol, Hanzepl 1,Postbus 30-001, NL-9700 RB Groningen, Netherlands.
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- Glimelius, Bengt (författare)
- Uppsala universitet,Science for Life Laboratory, SciLifeLab,Cancerprecisionsmedicin
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Karolinska Institutet Univ Groningen, Univ Med Ctr Groningen, Dept Med Oncol, Hanzepl 1,Postbus 30-001, NL-9700 RB Groningen, Netherlands (creator_code:org_t)
- ELSEVIER, 2023
- 2023
- Engelska.
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Ingår i: ESMO Open. - : ELSEVIER. - 2059-7029. ; 8:2
- Relaterad länk:
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https://urn.kb.se/re...
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https://doi.org/10.1...
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http://kipublication...
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Abstract
Ämnesord
Stäng
- Background: Pre-operative chemoradiotherapy (CRT) rather than radiotherapy (RT) has resulted in fewer locoregional recurrences (LRRs), but no decrease in distant metastasis (DM) rate for patients with locally advanced rectal cancer (LARC). In many countries, patients receive post-operative chemotherapy (pCT) to improve oncological outcomes. We investigated the value of pCT after pre-operative CRT in the RAPIDO trial.Patients and methods: Patients were randomised between experimental (short-course RT, chemotherapy and surgery) and standard-of-care treatment (CRT, surgery and pCT depending on hospital policy). In this substudy, we compared curatively resected patients from the standard-of-care group who received pCT (pCT+ group) with those who did not (pCT- group). Subsequently, patients from the pCT+ group who received at least 75% of the prescribed chemotherapy cycles (pCT >75% group) were compared with patients who did not receive pCT (pCT-/- group). By propensity score stratification (PSS), we adjusted for the following unbalanced confounders: age, clinical extramural vascular invasion, distance to the anal verge, ypT stage, ypN stage, residual tumour, serious adverse event (SAE) and/or readmission within 6 weeks after surgery and SAE related to pre-operative CRT. Cumulative probability of disease-free survival (DFS), DM, LRR and overall survival (OS) was analysed by Cox regression.Results: In total, 396/452 patients had a curative resection. The number of patients in the pCT+, pCT >75%, pCT- and pCT-/- groups was 184, 112, 154 and 149, respectively. The PSS-adjusted analyses for all endpoints demonstrated hazard ratios between approximately 0.7 and 0.8 (pCT+ versus pCT-), and 0.5 and 0.8 (pCT >75% versus pCT-/-). However, all 95% confidence intervals included 1.Conclusions: These data suggest a benefit of pCT after pre-operative CRT for patients with high-risk LARC, with approximately 20%-25% improvement in DFS and OS and 20%-25% risk reductions in DM and LRR. Compliance with pCT additionally reduces or improves all endpoints by 10%-20%. However, differences are not statistically significant.
Ämnesord
- MEDICIN OCH HÄLSOVETENSKAP -- Klinisk medicin -- Cancer och onkologi (hsv//swe)
- MEDICAL AND HEALTH SCIENCES -- Clinical Medicine -- Cancer and Oncology (hsv//eng)
- MEDICIN OCH HÄLSOVETENSKAP -- Klinisk medicin -- Kirurgi (hsv//swe)
- MEDICAL AND HEALTH SCIENCES -- Clinical Medicine -- Surgery (hsv//eng)
Nyckelord
- locally advanced rectal cancer
- post-operative chemotherapy
- oncological outcomes
- propensity score stratification
- adjuvant chemotherapy
Publikations- och innehållstyp
- ref (ämneskategori)
- art (ämneskategori)
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Till lärosätets databas
- Av författaren/redakt...
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Dijkstra, E. A.
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Zwart, W. H.
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Nilsson, P. J.
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Putter, H.
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Roodvoets, A. G. ...
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Kranenbarg, E. M ...
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visa fler...
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Froedin, J. E.
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Nygren, Peter
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ostergaard, L.
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Kersten, C.
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Verbiene, I.
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Cervantes, A.
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Hendriks, M. P.
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Capdevila, J.
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Edhemovic, I.
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van de Velde, C. ...
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Marijnen, C. A. ...
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van Etten, B.
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Hospers, G. A. P ...
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Glimelius, Bengt
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