Does Adjuvant Chemotherapy for Locally Advanced Resectable Rectal Cancer treated with Neoadjuvant Chemoradiotherapy have an impact on survival? A Single Moroccan Institute Retrospective Study.

BACKGROUND

In the locally advanced stage, the prognosis of rectal cancer was improved by preoperative chemoradiotherapy and radical surgery including complete total mesorectal excision. At present, the place of adjuvant chemotherapy remains controversial. We aimed to assess the impact of this chemotherapy on our patient survival.

METHODS AND MATERIALS

This is a retrospective study including patients with locally advanced resectable cancer in the middle and low rectum, treated by neoadjuvant chemoradiotherapy and radical surgery including complete total mesorectal excision at the Medical Oncology Department of the University Hospital Mohammed VI-Oujda, Morocco over a period of six years from January 2007 to December 2012. Patients were divided into two groups: with chemotherapy (Group A) and without it (Group B). In group A, adjuvant chemotherapy was started 4-8 weeks after surgery, constituted of CAPOX (Capecitabine and oxaliplatin) or Capecitabine alone for 8 cycles. We assessed the median overall survival (OS), the median disease-free survival (DFS), the 3-year OS and the 3-year DFS in both groups.

RESULTS

Forty patients were included in this study. Nineteen patients in group A: CAPOX (n= 14), Capecitabine alone (n=5). Twenty-one patients in group B. After a median follow-up of 57 months (range 7-129). Median OS was 94 months in the group A and 119 months in group B [HR = 1.773, 95% CI: 0.759-1.773; P =0.186]. Median DFS was 30 months in group A and 17 months in group B [HR= 1.898, 95% CI: 0.634-5.683; P =0.252]. 3-year OS was 86.4% in group A and 92.5% in group B [HR= 1.549, 95% CI: 0.548- 4.383; p= 0.409]. 3-year DFS was 66.7% in group A and 57.2% in group B [HR=2.166, 95% CI: 0.712- 6.591; p= 0.173].

CONCLUSION

Although there are some limitations in our study, namely its retrospective design and small size of the cohort, adjuvant chemotherapy for locally advanced resectable rectal cancer treated with neoadjuvant chemoradiotherapy did not improve OS nor DFS.