Adjuvant Treatment for Locally Advanced Rectal Cancer Patients After Preoperative Chemoradiotherapy: When, and for Whom?

作者：De Stefano Alfonso; Moretto Roberto; Bucci Luigi; Pepe Stefano; Romano Francesco Jacopo; Cella Alessandra Chiara; Attademo Laura; Rosanova Mario; De Falco Stefano; Fiore Giovanni; Raimondo Lucia; De Placido Sabino; Carlomagno Chiara^*

来源：Clinical Colorectal Cancer, 2014, 13(3): 185-191.

DOI：10.1016/j.clcc.2014.05.004

• Adjuvant chemotherapy
• Lymph nodes
• Preoperative chemoradiotherapy
• Prognostic factors
• Rectal cancer

The role and type of adjuvant chemotherapy in patients with rectal cancer after neoadjuvant chemoradiotherapy and surgery is controversial. Based on the retrospective analysis, we analyzed the prognostic factors that may influence the choice of adjuvant treatment. ypTNM stage significantly affects disease-free and overall survival; in particular patients with ypN+ are candidates for intensified adjuvant chemotherapy. Background: The standard treatment for patients with locally advanced rectal cancer (clinical tumor, node, metastases [TNM] stage II or III) is radiotherapy before surgery (with or without concomitant fluoropyrimidine-based chemotherapy) followed by surgery. The role of adjuvant chemotherapy in this setting of patients is controversial in terms of the overall benefit on survival, the subgroup of patients who might not need it, and the best regimen (combination regimens vs. fluoropyrimidine alone). Patients and Methods: Based on the retrospective analysis of the clinical outcome of all patients with locally advanced rectal adenocarcinoma treated at our institute during the past 9 years, we comment on prognostic factors for local and distant metastases of patients who received neoadjuvant treatment followed by surgery, and the scientific evidence that can help to decide the adjuvant chemotherapy. Results: We conclude that pathological TNM stage after neoadjuvant chemoradiation (ypTNM) stage after surgery significantly affects disease-free and overall survival. In particular, patients with pathologically positive lymph nodes (ypN+) after surgery have a high probability of developing distant metastases. Conclusion: ypN+ patients are candidate for intensified adjuvant chemotherapy.

• 出版日期2014-9