OVERVIEW OF DISCUSSIONS AND DECISION-MAKING ON TOTAL NEOADJUVANT THERAPY OF DISTAL RECTAL CANCER
DOI:
https://doi.org/10.32471/exp-oncology.2312-8852.vol-44-no-3.18497Keywords:
complex treatment, distal rectal cancer, drug treatment, radiation therapy, stages of treatment, total neoadjuvant therapyAbstract
Advances implemented in the complex treatment of distal rectal cancer led to a decrease in the number of loco-regional recurrences to 5–10%, but high rates of distant metastases remain at up to 30%. They lead to disappointing long-term oncological results, which requires the search for improvement of each of the stages of complex treatment. As a consequence of the questionable effectiveness of adjuvant polychemotherapy for distal rectal cancer, the question of the possibility of transferring drug treatment from an adjuvant to a neoadjuvant regimen is reasonably raised. The presented options for full neoadjuvant therapy have been developed and tested in leading oncology centers and are based on National Comprehensive Cancer Network Version 1.2022 recommendations. It is premature to make categorical conclusions regarding the recommendation of one or another variant of their implementation. Our preliminary clinical results confirmed the need for an additional stage of restaging in the second option, after 16 weeks of polychemotherapy before chemoradiation, in order to exclude the generalization of the disease. Therefore, there is a need for a prospective, controlled intercentre study to answer some unresolved questions.
References
Bray F, Ferlay J, Soerjomataram I, et al. Global cancer statistics 2018: GLOBOCAN estimates of incidence and mortality worldwide for 36 cancers in 185 countries. CA Cancer J Clin 2018; 68: 394–424. doi: https://doi.org/10.3322/caac.21492
Ludmir EB, Palta M, Willett CG, Czito BG. Total neoadjuvant therapy for rectal cancer: an emerging option. Cancer 2017; 123: 1497–506. doi: https://doi.org/10.1002/cncr.30600
Lakkis Z, Manceau G, Bridoux V, et al. Management of rectal cancer: the 2016 French guidelines. Colorectal Dis 2017; 19: 115–22. doi: https://doi.org/10.1111/codi.13550
Berho M, Narang R, Van Koughnett JA, et al. Modern multidisciplinary perioperative management of rectal cancer. JAMA Surg 2015; 150: 260–6. doi: https://doi.org/10.1001/jamasurg.2014.2887
Zaborowski A, Stakelum A, Winter DC. Systematic review of outcomes after total neoadjuvant therapy for locally advanced rectal cancer. Br J Surg 2019; 106: 979–87. doi: https://doi.org/10.1002/bjs.11171
Garcia-Aguilar J, Chow OS, Smith DD, et al. Effect of adding mFOLFOX6 after neoadjuvant chemoradiation in locally advanced rectal cancer: a multicentre, phase 2 trial. Lancet Oncol 2015; 16: 957–66. doi: https://doi.org/10.1016/S1470-2045(15)00004-2
Bujko K, Wyrwicz L, Rutkowski A, et al. Long-course oxaliplatin-based preoperative chemoradiation versus 5×5 Gy and consolidation chemotherapy for cT4 or fixed cT3 rectal cancer: results of a randomized phase III study. Ann Oncol 2016; 27: 834–42. doi: https://doi.org/10.1093/annonc/mdw062
Gao YH, Lin JZ, An X, et al. Neoadjuvant sandwich treatment with oxaliplatin and capecitabine administered prior to, concurrently with, and following radiation therapy in locally advanced rectal cancer: a prospective phase 2 trial. Int J Radiat Oncol Biol Phys 2014; 90: 1153–60. doi: https://doi.org/10.1016/j.ijrobp.2014.07.021
Sclafani F, Brown G, Cunningham D, et al. PAN-EX: a pooled analysis of 2 trials of neoadjuvant chemotherapy followed by chemoradiotherapy in MRI-defined, locally advanced rectal cancer. Ann Oncol 2016; 27: 1557–65. doi: https://doi.org/10.1093/annonc/mdw215
Nilsson PJ, van Etten B, Hospers GA, et al. Short-course radiotherapy followed by neo-adjuvant chemotherapy in locally advanced rectal cancer—the RAPIDO trial. BMC Cancer 2013; 13: 279. doi: https://doi.org/10.1186/1471-2407-13-279
The Association of Coloproctology of Great Britain and Ireland. Operable rectal cancer: survey of current practice and proposed phase III trial. Available at: http://www.acpgbi.org.uk/content/ uploads/2014/07/CREATE-Survey-2014.pdf. Accessed August 30, 2016.
Campos-Lobato LF, Alves-Ferreira PC, Lavery IC, Kiran RP. Abdominoperineal resection does not decrease quality of life in patients with low rectal cancer. Clinics 2011; 66: 1035–40. doi: https://doi.org/10.1590/S1807-59322011000600019
Habr-Gama A, Sabbaga J, Gama-Rodrigues J, et al. Watch and wait approach following extended neoadjuvant chemoradiation for distal rectal cancer: are we getting closer to anal cancer management? Dis Colon Rectum 2013; 56: 1109–17. doi: https://doi.org/10.1097/DCR.0b013e3182a25c4e
Habr-Gama A, Perez RO, Sao Juliao GP, et al. Consolidation chemotherapy during neoadjuvant chemoradiation (CRT) for distal rectal cancer leads to sustained decrease in tumor metabolism when compared to standard CRT regimen. Radiat Oncol 2016; 11: 24. doi: https://doi.org/10.1186/s13014-016-0598-6
Fernandez-Martos C, Garcia-Albeniz X, Pericay C, et al. Chemoradiation, surgery and adjuvant chemotherapy versus induction chemotherapy followed by chemoradiation and surgery: long-term results of the Spanish GCR-3 phase II randomized trial. Ann Oncol 2015; 26: 1722–8. doi: https://doi.org/10.1093/annonc/mdv223
Chua YJ, Barbachano Y, Cunningham D, et al. Neoadjuvant capecitabine and oxaliplatin before chemoradiotherapy and total mesorectal excision in MRI-defined poor-risk rectal cancer: a phase 2 trial. Lancet Oncol 2010; 11: 241–8. doi: https://doi.org/10.1016/S1470-2045(09)70381-X
Dewdney A, Cunningham D, Tabernero J, et al. Multicenter randomized phase II clinical trial comparing neoadjuvant oxaliplatin, capecitabine, and preoperative radiotherapy with or without cetuximab followed by total mesorectal excision in patients with high-risk rectal cancer (EXPERT-C). J Clin Oncol 2012; 30: 1620–7. doi: https://doi.org/10.1200/JCO.2011.39.6036
Perez K, Safran H, Sikov W, et al. Complete neoadjuvant treatment for rectal cancer: the Brown university oncology group CONTRE study. Am J Clin Oncol 2014; 40: 283–7. doi: https://doi.org/10.1097/COC. 0000000000000149
Memorial Sloan Kettering Cancer Center. Trial evaluating 3-year disease free survival in patients with locally advanced rectal cancer treated with chemoradiation plus induction or consolidation chemotherapy and total mesorectal excision or non-operative management (nct02008656). Available at: https://clinicaltrials.gov/ct2/show/NCT02008656. Accessed August 30, 2016.
Smith JJ, Chow OS, Gollub MJ, et al. Organ Preservation in Rectal Adenocarcinoma: a phase II randomized controlled trial evaluating 3-year disease-free survival in patients with locally advanced rectal cancer treated with chemoradiation plus induction or consolidation chemotherapy, and total mesorectal excision or nonoperative management. BMC Cancer 2015; 15: 767. doi: https://doi.org/10.1186/s12885-015-1632-z
Perez K, Safran H, Sikov W, et al. Complete neoadjuvant treatment for rectal cancer: the Brown University Oncology Group CONTRE study. Am J Clin Oncol 2017; 40: 283–7. doi: https://doi.org/10.1097/COC.0000000000000149
Golo D, But-Hadzic J, Anderluh F, et al. Induction chemotherapy, chemoradiotherapy and consolidation chemotherapy in preoperative treatment of rectal cancer — long-term results of phase II OIGIT-01 Trial. Radiol Oncol 2018; 52: 267–74. doi: https://doi.org/10.2478/raon-2018-0028
Yu X, Wang QX, Xiao WW, et al. Neoadjuvant oxaliplatin and capecitabine combined with bevacizumab plus radiotherapy for locally advanced rectal cancer: results of a single-institute phase II study. Cancer Commun (Lond) 2018; 38: 24. doi: https://doi.org/10.1186/s40880-018-0294-z
Kasi A, Abbasi S, Handa S, et al. Total neoadjuvant therapy vs standard therapy in locally advanced rectal cancer a systematic review and meta-analysis. JAMA Netw Open 2020; 3: e2030097. doi: https://doi.org/10.1001/jamanetworkopen.2020.30097
Ngan SY, Burmeister B, Fisher RJ, et al. Randomized trial of short-course radiotherapy versus long-course chemoradiation comparing rates of local recurrence in patients with T3 rectal cancer: Trans-tasman radiation oncology group trial 01.04. J Clin Oncol 2012; 30: 3827–33. doi: https://doi.org/10.1200/JCO.2012.42.9597
Latkauskas T, Pauzas H, Gineikiene I, et al. Initial results of a randomized controlled trial comparing clinical and pathological downstaging of rectal cancer after preoperative short-course radiotherapy or long-term chemoradiotherapy, both with delayed surgery. Colorectal Dis 2012; 14: 294–8. doi: https://doi.org/10.1111/j.1463-1318.2011.02815.x
Pettersson D, Lörinc E, Holm T, et al. Tumour regression in the randomized Stockholm III Trial of radiotherapy regimens for rectal cancer. Br J Surg 2015; 102: 972–8. doi: https://doi.org/10.1002/bjs.9811
Petrelli F, Sgroi G, Sarti E, et al. Increasing the interval between neoadjuvant chemoradiotherapy and surgery in rectal cancer: A meta-analysis of published studies. Ann Surg 2016; 263: 458–64. doi: https://doi.org/10.1097/SLA.0000000000000368
Humayun WA, Khokhar MA, Yaqub S, et.al. Randomized control trial to assess radiological and pathological response after neo adjuvant concomitant chemo radiotherapy vs. sequential short course radiotherapy (SCRT) followed by chemotherapy in locally advanced rectal cancer (LARC). Annals Oncol 2021; 5: S536. doi: https://doi.org/10.1016/j.annonc.2021.08.917
Zhao N, Lin CJ, Wang F, et al. Short-course or long-course radiation therapy as a part of a neoadjuvant regimen for stage II & III rectal adenocarcinoma? Chin J Cancer Res 2019; 31: 849–52 doi: https://doi.org/10.21147/j.issn.1000-9604.2019.06.01
Cohen BG, Hay J, Barzi A. Cost-effectiveness of short-course radiotherapy compared to long-course chemoradiotherapy in the treatment of stage III rectal cancer patients from the US societal perspective. Value in Health 2018; 21: S32.
Alliance for Clinical Trials in Oncology. PROSPECT: chemotherapy alone or chemotherapy plus radiation therapy in treating patients with locally advanced rectal cancer undergoing surgery (NCT01515787). Available at: https://clinicaltrials.gov/ct2/show/NCT01515787. Accessed August 30, 2016.
Glynne-Jones R, Hava N, Goh V, et al. Bevacizumab and combination chemotherapy in rectal cancer until surgery (BACCHUS): a phase II, multicentre, open-label, randomised study of neoadjuvant chemotherapy alone in patients with high-risk cancer of the rectum. BMC Cancer 2015; 15: 764. doi: https://doi.org/10.1186/s12885-015-1764-1
NCCN Guidelines Version 1.2022 Rectal Cancer. Available at: https://www.nccn.org/ professionals/ physician_gls/pdf/rectal.pdf
Downloads
Published
How to Cite
Issue
Section
License
Copyright (c) 2023 Experimental Oncology
This work is licensed under a Creative Commons Attribution-NonCommercial 4.0 International License.