Adoption of Total Neoadjuvant Therapy for Locally Advanced Rectal Cancer
Adoption of Total Neoadjuvant Therapy for Locally Advanced Rectal Cancer
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DOI：
10.1001/jamaoncol.2018.0071
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发表时间：
2018-06-01
期刊：
影响因子：
28.4
通讯作者：
Weiser, Martin R.
中科院分区：
文献类型：
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作者：
Cercek, Andrea;Roxburgh, Campbell S. D.;Weiser, Martin R.
局部进展期直肠癌（LARC）的治疗包括放化疗、手术和化疗。总的新辅助治疗（TNT）的概念，其中放化疗和化疗的管理手术前，已经开发出优化交付的有效的全身治疗，旨在micrometabolis.Objective比较传统的方法术前放化疗（chemRT），术后辅助化疗与最近TNT的LARC方法。设计、地点和参与者：回顾性队列分析，使用纪念斯隆-凯特琳癌症中心（MSK）2009年至2015年的记录。共确定了811例LARC患者（T3/4或淋巴结阳性）。在811例患者中，320例接受化疗RT与计划的辅助化疗，308例接受TNT（诱导氟尿嘧啶和奥沙利铂为基础的化疗，然后进行化疗RT）。在MSK接受所有治疗的患者亚组中评估处方化疗的剂量和完成情况。结果：在628例患者中，373例（59%）为男性，255例（41%）为女性，平均（5D）年龄为56.7（12.9）岁。TNT队列的308例患者中，181例（49%）为男性，127例（49%）为女性。在化疗RT与计划辅助化疗队列的320例患者中，192例（60%）为男性，128例（40%）为女性。TNT队列中的患者接受计划奥沙利铂和氟尿嘧啶处方剂量的百分比高于化疗RT+计划辅助化疗队列中的患者。完全缓解（CR）率，包括接受手术的患者的病理CR（pCR）和未接受手术的患者治疗后至少12个月的持续临床CR（cCR），TNT组中为36%，而chemRT+计划辅助化疗组中为21%。结论和相关性我们的研究结果为国家综合癌症网络（NCCN）提供了额外的支持。将TNT归类为直肠癌可行的治疗策略的指南。我们的数据表明TNT有助于提供计划的全身治疗。长期随访将确定这一发现是否转化为生存率的提高。此外，鉴于其高CR率，TNT可能有助于旨在保留器官的非手术治疗策略。
IMPORTANCE Treatment of locally advanced rectal (LARC) cancer involves chemoradiation, surgery, and chemotherapy. The concept of total neoadjuvant therapy (TNT), in which chemoradiation and chemotherapy are administered prior to surgery, has been developed to optimize delivery of effective systemic therapy aimed at micrometastases.OBJECTIVE To compare the traditional approach of preoperative chemoradiation (chemoRT) followed by postoperative adjuvant chemotherapy with the more recent TNT approach for LARC. DESIGN,SITTING, AND PARTICIPANTS A retrospective cohort analysis using Memorial Sloan Kettering Cancer Center (MSK) records from 2009 to 2015 was carried out. A total of 811 patients who presented with LARC (T3/4 or node-positive) were identified. EXPOSURES Of the 811 patients, 320 received chemoRT with planned adjuvant chemotherapy and 308 received TNT (induction fluorouracil- and oxaliplatin-based chemotherapy followed by chemoRT).MAIN OUTCOMES AND MEASURES Treatment and outcome data for the 2 cohorts were compared. Dosing and completion of prescribed chemotherapy were assessed on the subset of patients who received all therapy at MSK. RESULTS Of the 628 patients overall, 373 (59%) were men and 255 (41%) were women, with a mean (5D) age of 56.7 (12.9) years. Of the 308 patients in the TNT cohort, 181(49%) were men and 127 (49%) were women. Of the 320 patients in the chemoRT with planned adjuvant chemotherapy cohort, 192 (60%) were men and 128 (40%) were women. Patients in the TNT cohort received greater percentages of the planned oxaliplatin and fluorouracil prescribed dose than those in the chemoRT with planned adjuvant chemotherapy cohort. The complete response (CR) rate, including both pathologic CR (pCR) in those who underwent surgery and sustained clinical CR (cCR) for at least 12 months posttreatment in those who did not undergo surgery, was 36% in the TNT cohort compared with 21% in the chemoRT with planned adjuvant chemotherapy cohort.CONCLUSIONS AND RELEVANCE Our findings provide additional support for the National Comprehensive Cancer Network (NCCN) guidelines that categorize TNT as a viable treatment strategy for rectal cancer. Our data suggest that TNT facilitates delivery of planned systemic therapy. Long-term follow-up will determine if this finding translates into improved survival. In addition, given its high CR rate, TNT may facilitate nonoperative treatment strategies aimed at organ preservation.