Published online Sep 15, 2022. doi: 10.4251/wjgo.v14.i9.1711
Peer-review started: April 29, 2022
First decision: July 6, 2022
Revised: July 14, 2022
Accepted: August 9, 2022
Article in press: August 9, 2022
Published online: September 15, 2022
Processing time: 133 Days and 5.9 Hours
Patients with locally advanced rectal cancer (LARC) who achieved complete response (CR) after neoadjuvant therapy had a better prognosis, but the optimal neoadjuvant therapy regimen remained unclear.
Several studies have suggested that consolidation chemotherapy (CC) after neoadjuvant chemoradiotherapy (NCRT) seemed to improve CR rate, however it also prolonged interval between NCRT and surgery, making surgery more difficult. Besides, in the concurrent chemotherapy, the additional oxaliplatin not only increased toxicity but also failed to improve the efficacy. Further, high-risk patients with LARC were less likely to achieve CR, and had worse prognosis than patients in low-risk. Considering the efficacy and low toxicity of capecitabine in the treatment of rectal cancer and the convenience of oral therapy, we designed this retrospective study.
To evaluate the effects of one to two cycles of CC with capecitabine in high-risk patients with LARC without extending NCRT and surgery interval.
From January 2015 to July 2019, high-risk patients with LARC were divided into the CC and non-CC group according to whether they received CC after NCRT. Propensity score matching (PSM) and inverse probability of treatment weight (IPTW) were used to balance the differences between the two groups.
After PSM and IPTW, the CR rate in the CC group was higher than that in the non-CC group. The median follow-up was over three years, and there were no differences in 3-year non-regrowth disease-free survival nor overall survival in the two groups. There was also no increase in acute toxicity in the CC group.
Our study first confirmed without extending the interval between the end of NCRT and surgery, one to two cycles of CC with capecitabine after NCRT was safe and increased the CR rate in high-risk patients with LARC. However, it failed to improve long-term outcomes.
Further studies with more participants and a longer follow-up period need to be investigated to confirm these findings.