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 |
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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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