Intensified Total Neoadjuvant Therapy Versus Intensified Concurrent Chemoradiotherapy in Locally Advanced Rectal Cancer: A Propensity Score Matching Analysis

• Published in: Anticancer research 2022-02, Vol.42 (2), p.991-1000
• Main Authors: DE Felice, Francesca, Musio, Daniela, Iafrate, Franco, Caponnetto, Salvatore, Picone, Vincenzo, D'Ambrosio, Giancarlo, Magliocca, Fabio Massimo, Tozzi, Francesca, DE Toma, Giorgio, Tombolini, Vincenzo, Cortesi, Enrico
• Format: Article
• Language: English
• Subjects: 5-Fluorouracil; Adenocarcinoma - mortality; Adenocarcinoma - pathology; Adenocarcinoma - therapy; Adult; Aged; Aged, 80 and over; Antineoplastic Combined Chemotherapy Protocols - therapeutic use; Bevacizumab; Cancer; Cancer therapies; Chemoradiotherapy; Chemoradiotherapy - methods; Chemotherapy; Colorectal cancer; Disease Progression; Dose-Response Relationship, Drug; Female; Follow-Up Studies; Humans; Italy - epidemiology; Male; Matched-Pair Analysis; Matching; Metastases; Middle Aged; Multiagent systems; Neoadjuvant Therapy - methods; Neoplasm Invasiveness; Oxaliplatin; Patients; Propensity Score; Radiation therapy; Rank tests; Rectal Neoplasms - mortality; Rectal Neoplasms - pathology; Rectal Neoplasms - therapy; Rectum; Statistical analysis; Survival; Survival Analysis; Young Adult
• ISSN: 0250-7005; 1791-7530
• DOI: 10.21873/anticanres.15559

To compare clinical outcomes following intensified total neoadjuvant therapy (TNT) and intensified neoadjuvant chemoradiotherapy (CRT) in patients with locally advanced rectal cancer (LARC). Of the 79 patients with LARC admitted to our department, 51 received intensified neoadjuvant CRT (CRT group) and 28 received intensified TNT (TNT group). Intensified TNT was defined as multi-agent chemotherapy, including FOLFOXIRI regimen plus bevacizumab (mutated Ras-BRAF) or panitumumab/cetuximab (wild-type Ras-BRAF) followed by oxaliplatin-5-fluorouracil-based CRT and surgery. Kaplan-Meier and Log rank test were used for survival analysis. Survival rates of the two groups were compared using propensity score matching. Data from 28 TNT patients and 28 CRT patients were analyzed after a 1:1 propensity matching with replacement. Kaplan-Meier curve showed that overall survival (OS), disease-free survival (DFS) and distant metastasis-free survival (DMFS) rates with TNT were comparable to those with CRT. The 5-year DMFS rates for TNT and CRT were 61.5% versus 63.0% (p=0.82), respectively. In the TNT group, 32.1% patients (n=9) achieved pathological complete response (pCR), whereas 21.4% patients (n=6) achieved pCR with CRT (p=0.37). Intensified TNT and CRT resulted in similar survival outcomes, while intensified TNT led to higher pCR, albeit not statistically significant.