<--GAT-->
Clinical Topics

Adjuvant Chemotherapy Improves Survival in Rectal Cancer

by U.S. Medicine

June 15, 2018

DURHAM, NC — The standard of care for locoregionally advanced rectal cancer (LARC) in the United States usually involves adjuvant chemotherapy (AC) following chemoradiation (CRT) and total mesorectal excision (TME).

The concern raised by a new study in the Journal of Clinical Oncology, however, is that data proving benefits have been lacking.1

Researchers from the Durham, NC, VAMC and Duke University Medical Center sought to remedy that, by examining the role, optimal regimen and duration of AC in the mandatory, prospectively collected cancer registry of the largest integrated health system in the United States.

To accomplish that, the study team used the VA Central Cancer Registry, including Stage II-III rectal cancer patients diagnosed between January 2001 and April 2011, if they received neoadjuvant CRT, followed by TME, with or without AC.

At least four months of therapy was defined as “adequate chemotherapy,” and survival outcomes were compared. Overall, 649 patients were identified, with 323 receiving AC, while 326 did not (OBS). For the mostly white and male group, mean age 63, median follow-up was 66 months. Almost half of the patients, 49.2% had Stage II disease.

Results indicated that median overall survival (OS) for all patients was 92 months, with six-year OS at 56.8%. Median OS was 72 months for the OBS group and not reached (NR) for the AC group (p < 0.001).

Six-year OS was 49.5% for OBS and 64.1% for AC (p < 0.0001). On PS matched analysis, OS was improved, favoring AC (p < 0.0001).

The researchers reported that median disease-specific survival (DSS) was NR for the whole group and NR for the OBS and AC groups. At six years, DSS was 73.6% for the whole group and 67.9% for OBS vs. 79.2% for AC (p < 0.001). The study team concluded that PS matched analysis for DSS favored AC (p = 0.0004).

No significant difference was detected in OS (p = 0.554) or DSS (p = 0.680) when comparing single vs. multiagent chemotherapy and no significant difference in OS (p = 0.766) or DSS (p = 0.271) when comparing adequate vs. inadequate chemotherapy.

“In this VA population of LARC patients treated with neoadjuvant CRT followed by TME, the addition of AC was found to improve both OS and DSS compared to OBS,” the study authors concluded. “There was no improvement in OS or DSS with the addition of a multi-agent over single-agent chemotherapy.”


1Spiegel D, Boyer M, Hong JC, Williams CD, e. al. Role of adjuvant chemotherapy following chemoradiation and surgery for locoregionally advanced rectal cancer: A Veterans Health Administration analysis. Journal of Clinical Oncology 2018 36:4_suppl, 741-741.

Comments are closed here.


Related Articles

Physician Documents, Promotes Veteran Honor Guards in VA Hospices

PHILADELPHIA—Michelle Brassil, MD, had been warned when she began her fellowship at the Cpl. Michael J. Crescenz VA Medical Center’s Community Living Center in Philadelphia. “Don’t be surprised if you’re emotional,” her supervisor told her.... View Article

Lack of DoD/VA Decision-Maker Could Hamper EHR Implementation

WASHINGTON—Plans are moving ahead for VA’s 10-year, $16 billion effort to modernize its electronic health record system, but legislators still have questions about the project’s timeline and funding, as well as concerns about the project’s... View Article


U.S. Medicine Recommends


More From oncology

Oncology

Surgical Staging Often Inadequate for Gallbladder Cancer

Guidelines frequently aren’t followed when it comes to radical cholecystectomy with regional lymphadenectomy for patients with T1b gallbladder cancer.

Oncology

Use of Hospice During Treatment Has Limited VA Use

Unlike in most private sector settings, veterans with advanced cancer can receive hospice care concurrently with treatments such as radiation and chemotherapy.

Oncology

Hypertension, MGUS Associated with Herbicide Exposure in Vietnam Veterans

Based on a new review, two conditions–one extremely common and the other rare–appear to be related to herbicide exposure during the Vietnam War era.

Oncology

Detailed Medical History Crucial for Lung Disease Diagnosis

Both general medicine physicians and specialists can find interstitial lung disease (ILD) and pulmonary fibrosis confusing, according to a recent study.

Oncology

Melanomas Associated With Internal Malignancy Risk

Genetic and environmental risk factors have been associated with the development of multiple primary melanomas (MPM) but a new study questioned whether those patients might have increased predisposition to developing internal malignancies.

Subscribe to U.S. Medicine Print Magazine

U.S. Medicine is mailed free each month to physicians, pharmacists, nurse practitioners, physician assistants and administrators working for Veterans Affairs, Department of Defense and U.S. Public Health Service.

Subscribe Now

Receive Our Email Newsletter

Stay informed about federal medical news, clinical updates and reports on government topics for the federal healthcare professional.

Sign Up