Feasibility and Efficacy of Neoadjuvant Chemotherapy without Radiotherapy for Locally Advanced Rectal Cancer

Katsuji Tokuhara; Yuki Matsui; Yosuke Ueyama; Kazuhiko Yoshioka; Mitsugu Sekimoto

doi:10.23922/jarc.2021-033

Feasibility and Efficacy of Neoadjuvant Chemotherapy without Radiotherapy for Locally Advanced Rectal Cancer

J Anus Rectum Colon. 2022 Jan 28;6(1):24-31. doi: 10.23922/jarc.2021-033. eCollection 2022.

Authors

Katsuji Tokuhara^{1

2}, Yuki Matsui^{1

2}, Yosuke Ueyama^{1

2}, Kazuhiko Yoshioka^{1

2}, Mitsugu Sekimoto²

Affiliations

¹ Department of Gastroenterological Surgery, Kansai Medical University Medical Center, Osaka, Japan.
² Department of Surgery, Kansai Medical University, Osaka, Japan.

Abstract

Objectives: This retrospective study explored the feasibility of neoadjuvant chemotherapy (NAC) without radiotherapy in patients with locally advanced rectal cancer (LARC).

Methods: Patients with clinical stage of T3-T4 and/or N-positive LARC patients were included. We retrospectively analyzed patients' NAC-related and perioperative outcomes.

Results: The study enrolled 30 patients. mFOLFOX6 or SOX plus cetuximab was administered to 12 patients with the wild-type RAS gene and FOLFOXIRI or SOXIRI to 18 patients with mutant-type RAS. The NAC completion rate was 90.0%. All patients underwent total mesorectal excision, and 29 patients underwent combined bilateral lateral lymph node dissection. The R0 operation rate was 90.0%. Although the postoperative complication rate was 40%, no complications were associated with NAC. The response rate of NAC and the proportion of histological anti-tumor effect grade ≥ 2 were 56.7% and 46.7%, respectively.

Conclusions: NAC was considered to be a safe, feasible treatment option for LARC.

Keywords: FOLFOXIRI; cetuximab; mFOLFOX6; neoadjuvant chemotherapy; rectal cancer.