TITLE:
Stage II/III Rectal Cancer Patients Benefit from Extremely Early Initiation of Postoperative Adjuvant Chemotherapy: A Retrospective Study
AUTHORS:
Liuniu Xiao, Li Zhu, Yingming Chen, Zhenlin Hou, Lingwei Jia, Junbo Hu, Yongdong Feng
KEYWORDS:
Rectal Cancer, Postoperative Adjuvant Chemotherapy, Prognosis, Quality of Life, Chemotherapy-Associated Adverse Reaction
JOURNAL NAME:
Journal of Cancer Therapy,
Vol.10 No.1,
January
18,
2019
ABSTRACT: Background: For Stage II/III rectal cancer patients, curative resection
is the primary treatment, prescribing of postoperative adjuvant chemotherapy (PAC)
is regarded as a standard therapy. The interval between surgery and the initiation of PAC
is usually within 8 weeks. However, the optimal cut-off is still controversial. This study aimed to explore the
impact of extremely early initiation of PAC for II/III rectal cancer. Methods: Patients with Stage II/III rectal cancer treated from January 2013 to December 2015
were retrospectively collected at the Department of Tongji Hospital. According to
the starting point of PAC, patients were categorized into two groups: extremely
early group (The interval of PAC ≤ 2 weeks) and normal group (The interval of PAC
within 3 - 5 weeks). For the sake of evaluating the effectiveness of different intervals,
Overall Survival rate (OS), Progress-Free Survival rate (PFS) and Recurrence or
Metastasis Rate (RMR) were analyzed, as well as the Quality of Life Score. To estimate
the safety of the extremely early PAC, we evaluated the first post chemotherapy adverse reactions
and defecation ability, and analyzed the variance laboratory indexes around the
first postoperative adjuvant chemotherapy. Results: A total of 267 patients
were included in this study. Compared to normal group (192 cases), extremely early
group (75 cases) of patients attained a better tendency of OS and PFS, although
there were no significant statistical differences (OS: P = 0.0930; PFS: P = 0.1058).
However, the RMR was significant lower (P = 0.0452) and the Quality of Life Score was significantly higher (P = 0.0090) in extremely
early group. Multivariate analysis also showed that extremely early group had better
defecation ability (P = 0.0149) and less side reactions of post chemotherapy, such as vomiting
(P , got a higher level of inflammatory
cells (P Conclusion: For Stage II/III rectal cancer patients, extremely early
to start PAC not only might be effectively prolonging the survival, but indeed decrease
the tumor-related recurrence risk, increase the quality of life and decrease chemotherapy-associated
adverse reactions. Meanwhile, appropriately controlling of inflammatory cells and
protecting the liver function should be of concern to ensure the safety of early
initial stage.