Induction Chemotherapy Reduces Patient-reported Toxicities During Neoadjuvant Chemoradiation with Intensity Modulated Radiotherapy for Rectal Cancer

Autor: Zsofia K. Stadler, Philip B. Paty, Lajhem Cambridge, Neil H. Segal, Jose G. Guillem, Julio Garcia-Aguilar, S.Y. Ng, Leonard B. Saltz, Garrett M. Nash, Kathryn L. Colborn, Martin R. Weiser, Karyn A. Goodman, Andrea Cercek, Diane Reidy-Lagunes
Rok vydání: 2019
Předmět:
Adult
Diarrhea
Male
medicine.medical_specialty
Organoplatinum Compounds
Leucovorin
Hemorrhage
Article
Young Adult
03 medical and health sciences
0302 clinical medicine
FOLFOX
Internal medicine
Antineoplastic Combined Chemotherapy Protocols
medicine
Humans
Patient Reported Outcome Measures
Rectal Pain
Proctitis
Aged
Retrospective Studies
Aged
80 and over
Proctectomy
Rectal Neoplasms
business.industry
Standard treatment
Rectum
Gastroenterology
Induction chemotherapy
Common Terminology Criteria for Adverse Events
Chemoradiotherapy
Adjuvant
Induction Chemotherapy
Odds ratio
Middle Aged
Urination Disorders
medicine.disease
Neoadjuvant Therapy
Oncology
030220 oncology & carcinogenesis
Female
030211 gastroenterology & hepatology
Fluorouracil
Radiotherapy
Intensity-Modulated
business
Chemoradiotherapy
medicine.drug
Zdroj: Clin Colorectal Cancer
ISSN: 1533-0028
Popis: Initial treatment with either neoadjuvant chemoradiation (CRT) or induction FOLFOX (5-Fluorouracil, leucovorin, and oxaliplatin) chemotherapy followed by CRT is considered standard treatment for locally advanced rectal cancer. We compared patient-reported outcomes (PRO) during CRT in patients who had received induction chemotherapy versus those who did not.We reviewed records of patients with locally advanced rectal cancer who were treated with CRT between September 2009 and October 2014, and who had completed ≥ 4 PRO assessments during treatment. Clinician- and patient-reported toxicities were collected each week during treatment. We fit binomial generalized linear models to maximum toxicity scores across all patients' visits.Of 123 patients with ≥ 4 PRO assessments, 87 (71%) patients reported a clinically meaningful PRO score of 3 or higher for diarrhea, and 91 (74%) patients reported a PRO score of ≥ 3 for urgency, during 1 or more weeks of treatment, corresponding to 'very frequent' or worse. Of 116 patients who had also completed ≥ 4 clinician-reported assessments for descriptive analysis, clinically significant diarrhea (Common Terminology Criteria for Adverse Events grade ≥ 2) was reported in 9% of patients, and grade 2 proctitis and cystitis were reported in 20% and 4%, respectively. Eighty-four (68%) patients had undergone induction chemotherapy prior to CRT. Patients who received induction chemotherapy had 68% lower odds of experiencing significant urgency (odds ratio [OR], 0.32; 95% confidence interval [CI], 0.11-0.95; P = .04), 76% lower odds of bleeding (OR, 0.24; 95% CI, 0.1-0.62; P .01), and 75% lower odds of tenesmus (OR, 0.25; 95% CI, 0.11-0.6; P .01) versus those treated with upfront CRT.Based on PROs, a high proportion of patients experienced clinically significant symptoms during pelvic CRT, with diarrhea and urgency being most commonly reported. This appears to be under-reported on clinician-reported assessments. Delivery of induction chemotherapy was associated with lower odds of experiencing urgency, bleeding, and tenesmus on PROs during subsequent CRT, with no significant impact on diarrhea and rectal pain.
Databáze: OpenAIRE
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