The value of post-operative chemotherapy after chemoradiotherapy in patients with high-risk locally advanced rectal cancer-results from the RAPIDO trial
Copyright © 2023 The Author(s). Published by Elsevier Ltd.. All rights reserved..
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.
| Medienart: |
E-Artikel |
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| Erscheinungsjahr: |
2023 |
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| Erschienen: |
2023 |
| Enthalten in: |
Zur Gesamtaufnahme - volume:8 |
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| Enthalten in: |
ESMO open - 8(2023), 2 vom: 16. Apr., Seite 101158 |
| Sprache: |
Englisch |
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| Beteiligte Personen: |
Dijkstra, E A [VerfasserIn] |
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| Links: |
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| Anmerkungen: |
Date Completed 25.04.2023 Date Revised 08.05.2023 published: Print-Electronic Citation Status MEDLINE |
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| doi: |
10.1016/j.esmoop.2023.101158 |
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| funding: |
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| Förderinstitution / Projekttitel: |
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NLM353772828 |
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| 100 | 1 | |a Dijkstra, E A |e verfasserin |4 aut | |
| 245 | 1 | 4 | |a The value of post-operative chemotherapy after chemoradiotherapy in patients with high-risk locally advanced rectal cancer-results from the RAPIDO trial |
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| 500 | |a Date Revised 08.05.2023 | ||
| 500 | |a published: Print-Electronic | ||
| 500 | |a Citation Status MEDLINE | ||
| 520 | |a Copyright © 2023 The Author(s). Published by Elsevier Ltd.. All rights reserved. | ||
| 520 | |a 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 | ||
| 520 | |a 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 | ||
| 520 | |a 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 | ||
| 520 | |a 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 | ||
| 650 | 4 | |a Randomized Controlled Trial | |
| 650 | 4 | |a Journal Article | |
| 650 | 4 | |a Research Support, Non-U.S. Gov't | |
| 650 | 4 | |a adjuvant chemotherapy | |
| 650 | 4 | |a locally advanced rectal cancer | |
| 650 | 4 | |a oncological outcomes | |
| 650 | 4 | |a post-operative chemotherapy | |
| 650 | 4 | |a propensity score stratification | |
| 700 | 1 | |a Zwart, W H |e verfasserin |4 aut | |
| 700 | 1 | |a Nilsson, P J |e verfasserin |4 aut | |
| 700 | 1 | |a Putter, H |e verfasserin |4 aut | |
| 700 | 1 | |a Roodvoets, A G H |e verfasserin |4 aut | |
| 700 | 1 | |a Meershoek-Klein Kranenbarg, E |e verfasserin |4 aut | |
| 700 | 1 | |a Frödin, J E |e verfasserin |4 aut | |
| 700 | 1 | |a Nygren, P |e verfasserin |4 aut | |
| 700 | 1 | |a Østergaard, L |e verfasserin |4 aut | |
| 700 | 1 | |a Kersten, C |e verfasserin |4 aut | |
| 700 | 1 | |a Verbiené, I |e verfasserin |4 aut | |
| 700 | 1 | |a Cervantes, A |e verfasserin |4 aut | |
| 700 | 1 | |a Hendriks, M P |e verfasserin |4 aut | |
| 700 | 1 | |a Capdevila, J |e verfasserin |4 aut | |
| 700 | 1 | |a Edhemovic, I |e verfasserin |4 aut | |
| 700 | 1 | |a van de Velde, C J H |e verfasserin |4 aut | |
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| 700 | 1 | |a Glimelius, B |e verfasserin |4 aut | |
| 700 | 0 | |a collaborative investigators |e verfasserin |4 aut | |
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