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A Randomized Phase 2 Trial of Consolidation Chemotherapy After Preoperative Chemoradiation Therapy Versus Chemoradiation Therapy Alone for Locally Advanced Rectal Cancer: KCSG CO 14-03
- Source :
- International journal of radiation oncology, biology, physics. 101(4)
- Publication Year :
- 2017
-
Abstract
- Purpose Preoperative chemoradiation therapy (CRT) followed by total mesorectal excision (TME) in locally advanced rectal cancer is the standard of care. To date, the role of consolidation chemotherapy after CRT has rarely been addressed through randomized trials. This study aimed to evaluate the efficacy of CRT followed by consolidation chemotherapy compared with CRT alone. Methods and Materials This study enrolled patients with adenocarcinoma of the rectum and cT3 or cT4 disease with any N category and no metastasis. In arm A (control arm), we planned CRT (50.4 Gy in 28 fractions) with capecitabine followed by TME. In arm B, 2 cycles of capecitabine and oxaliplatin were administered 1 week after the completion of CRT before TME (capecitabine, 1700 mg/m2 per day from day 1 to 14, and oxaliplatin, 100 mg/m2 on day 1, every 3 weeks). The downstaging rate (the proportion of ypT0 to ypT2 and ypN0M0) was the primary endpoint, which was to be tested with a 1-sided type I error of 15% and with 85% power. Results From September 2014 to February 2016, 110 patients (56 in arm A and 54 in arm B) were randomized and 108 (55 in arm A and 53 in arm B) started CRT. TME was conducted per protocol in 96 patients (52 in arm A and 44 in arm B). In arms A and B, downstaging was achieved in 21.2% and 36.4% (P = .077), respectively, and the pathologic complete response rate was 5.8% and 13.6% (P = .167), respectively. Grade ≥3 adverse events occurred in 3.6% of patients in arm A and 9.4% of patients in arm B during the preoperative treatment phase and in 1.9% and 9.0%, respectively, during the postoperative recovery phase. Conclusions Consolidation chemotherapy with 2 cycles of capecitabine and oxaliplatin demonstrated a marginal improvement in the downstaging rate. However, a phase 3 trial of this strategy is discouraged because of the high dropout rate and safety issues.
- Subjects :
- 0301 basic medicine
Male
Cancer Research
medicine.medical_specialty
Patient Dropouts
Colorectal cancer
Antineoplastic Agents
Adenocarcinoma
Preoperative care
Drug Administration Schedule
law.invention
Capecitabine
03 medical and health sciences
0302 clinical medicine
Randomized controlled trial
law
Antineoplastic Combined Chemotherapy Protocols
Preoperative Care
Clinical endpoint
medicine
Humans
Radiology, Nuclear Medicine and imaging
Neoplasm Staging
Radiation
business.industry
Rectal Neoplasms
Consolidation Chemotherapy
Chemoradiotherapy
Middle Aged
medicine.disease
Total mesorectal excision
Surgery
Oxaliplatin
030104 developmental biology
Oncology
030220 oncology & carcinogenesis
Female
Dose Fractionation, Radiation
business
medicine.drug
Subjects
Details
- ISSN :
- 1879355X
- Volume :
- 101
- Issue :
- 4
- Database :
- OpenAIRE
- Journal :
- International journal of radiation oncology, biology, physics
- Accession number :
- edsair.doi.dedup.....c10285065c3b9eeb285b1691d8de4353