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01.02.2014 | Original article

Preoperative chemoradiation with or without induction oxaliplatin plus 5-fluorouracil in locally advanced rectal cancer

Long-term outcome analysis

verfasst von: F.A. Calvo, M.D., Ph.D., Dr. C.V. Sole, M.D., J. Serrano, M.D., Ph.D., E. del Valle, M.D., M. Rodriguez, M.D., A. Muñoz-Calero, M.D., J.L. García-Sabrido, M.D., Ph.D., P. Garcia-Alfonso, M.D., I. Peligros, M.D., E. Alvarez, M.D.

Erschienen in: Strahlentherapie und Onkologie | Ausgabe 2/2014

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Abstract

Background and purpose

It has been previously reported that a short FOLFOX-4 induction significantly improves pathologic complete response in locally advanced rectal cancer (LARC) patients treated with preoperative chemoradiation (CRT). In a larger and updated patient series, we analyzed FOLFOX-4 efficacy in terms of sphincter preservation and long-term outcomes.

Patients and methods

From January 1995 to December 2010, 335 LARC patients were treated with preoperative chemoradiation (4500–5040 cGy). Starting in May 2001, 207 consecutive patients additionally received induction FOLFOX-4. Surgery was performed 6 weeks (range 3–12 weeks) after chemoradiation.

Results

Incidence of total tumor (63 vs. 54 %, p = 0.02) and nodal downstaging (60 vs. 43 %, p = 0.002) was significantly increased by induction FOLFOX-4. In an analysis of tumors located below 5 cm from the anal verge (n = 114, 34 %), sphincter preservation was feasible in 30 % in the FOLFOX-4 versus 13 % in the upfront CRT group (p = 0.04). Median follow-up time for the entire cohort of patients was 72.6 months (range 4–205 months). FOLFOX-4 was not associated with superior locoregional control (HR 0.88, p = 0.78), disease-free survival (HR 0.83, p = 0.55), distant metastases-free survival (HR 0.94, p = 0.81), or cancer-specific survival (HR 0.70, p = 0.15).

Conclusion

Short-intense induction FOLFOX-4 significantly improves downstaging and sphincter preservation in low rectal tumors. Long-term outcomes were not improved in the FOLFOX-4 group of patients.

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Titel: Preoperative chemoradiation with or without induction oxaliplatin plus 5-fluorouracil in locally advanced rectal cancer
Long-term outcome analysis
verfasst von: F.A. Calvo, M.D., Ph.D.
Dr. C.V. Sole, M.D.
J. Serrano, M.D., Ph.D.
E. del Valle, M.D.
M. Rodriguez, M.D.
A. Muñoz-Calero, M.D.
J.L. García-Sabrido, M.D., Ph.D.
P. Garcia-Alfonso, M.D.
I. Peligros, M.D.
E. Alvarez, M.D.
Publikationsdatum: 01.02.2014
Verlag: Springer Berlin Heidelberg
Erschienen in: Strahlentherapie und Onkologie / Ausgabe 2/2014
Print ISSN: 0179-7158
Elektronische ISSN: 1439-099X
DOI: https://doi.org/10.1007/s00066-013-0469-0

Springer Medizin

Preoperative chemoradiation with or without induction oxaliplatin plus 5-fluorouracil in locally advanced rectal cancer

Long-term outcome analysis