Surgical outcomes of post chemoradiotherapy unresectable locally advanced rectal cancers improve with interim chemotherapy, is FOLFIRINOX better than CAPOX?

Autor:	Ostwal V; Department of Medical Oncology, TMH, Mumbai 400012, India., Engineer R; Department of Radiation Oncology, TMH, Mumbai 400012, India., Ramaswamy A; Department of Medical Oncology, TMH, Mumbai 400012, India., Sahu A; Department of Medical Oncology, TMH, Mumbai 400012, India., Zanwar S; Department of Medical Oncology, TMH, Mumbai 400012, India., Arya S; Department of Radiology, TMH, Mumbai 400012, India., Chopra S; Department of Radiation Oncology, TMH, Mumbai 400012, India., Bal M; Department of Pathology, TMH, Mumbai 400012, India., Patil P; Department of Medical Gastroenterology, TMH, Mumbai 400012, India., Desouza A; Department of Surgical Oncology, TMH, Mumbai 400012, India., Saklani A; Department of Surgical Oncology, TMH, Mumbai 400012, India.
Jazyk:	angličtina
Zdroj:	Journal of gastrointestinal oncology [J Gastrointest Oncol] 2016 Dec; Vol. 7 (6), pp. 958-967.
DOI:	10.21037/jgo.2016.08.11
Abstrakt:	Background: Role of chemotherapy in patients who continue to have unresectable disease after pre-operative chemo-radiotherapy (CRT) remains largely unaddressed. Methods: Patients with LA rectal cancer from January 2013 to June 2015 were evaluated. Post-CRT, patients, who were deemed unresectable, were considered for further interim chemotherapy (i-CT). Results: Seventy six patients (15%) with median age of 38.5 years received i-CT after CRT. About 61.8% patients receiving i-CT managed to undergo a definitive surgery and the extent of surgery was reduced in 48.7% patients. With the median follow up of 19 months, the estimated 2-year event free survival (EFS) of 48% and OS was 56%. The estimated 2-year OS was 81% in mucinous tumors whereas it was 44.4% in signet ring pathology (P=0.045). The 2-year OS of 86% for whom surgery was done vs. 38% (2-year OS) in whom surgery was not done (P=0.011). Survival was better in conservative surgery group vs . total pelvic exenteration (TPE) vs. no surgery (2-year OS: 84% vs . 59.1% vs . 38%; P=0.033). In the CAPE-OX group, 71.4% (14/23) underwent surgery whereas 75.9% (29/47) in the 5-FU plus irinotecan plus oxaliplatin (FOLFIRINOX) group with EFS (P=0.570) and OS (P=0.120). In conservative surgery group, OS was better in FOLFIRINOX (2-year OS: 95.7%) vs . capecitabine plus oxaliplatin (CAPOX) (2-year OS: 70%) (P=0.012). Conclusions: i-CT can lead to improved resection rates, improved survivals and downstaging with acceptable toxicity. FOLFIRINOX appears to better over CAPOX, specifically in whom conservative surgery is feasible. Competing Interests: The authors have no conflicts of interest to declare.
Databáze:	MEDLINE
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