Copyright
©The Author(s) 2020. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Gastrointest Oncol. Mar 15, 2020; 12(3): 311-322
Published online Mar 15, 2020. doi: 10.4251/wjgo.v12.i3.311
Impact of preoperative chemoradiotherapy using concurrent S-1 and CPT-11 on long-term clinical outcomes in locally advanced rectal cancer
Kei Kimura, Naohito Beppu, Hiroshi Doi, Kozo Kataoka, Tomoki Yamano, Motoi Uchino, Masataka Ikeda, Hiroki Ikeuchi, Naohiro Tomita
Kei Kimura, Naohito Beppu, Kozo Kataoka, Tomoki Yamano, Masataka Ikeda, Naohiro Tomita, Division of Lower Gastrointestinal Surgery, Department of Surgery, Hyogo College of Medicine, Nishinomiya, Hyogo 663-8501, Japan
Hiroshi Doi, Department of Radiology, Hyogo College of Medicine, Nishinomiya, Hyogo 663-8501, Japan
Hiroshi Doi, Department of Radiation Oncology, Kindai University Faculty of Medicine, Sayama, Osaka 589-8511, Japan
Motoi Uchino, Hiroki Ikeuchi, Department of Inflammatory Bowel Disease, Division of Surgery, Hyogo College of Medicine, Nishinomiya, Hyogo 663-8501, Japan
Author contributions: All authors helped to perform the research; Kimura K manuscript writing, performing procedures and data analysis; Beppu N contributed to manuscript writing, drafting conception and design, performing experiments, and data analysis; Doi H, Kataoka K, Yamano T, Uchino M, Ikeda M, Ikeuchi H and Tomita N contributed to writing of the manuscript.
Institutional review board statement: The protocol was approved by the Institutional Review Board at Hyogo College of Medicine, Japan (No.2756).
Informed consent statement: Patients were not required to give informed consent to the study because the analysis used anonymous clinical data that were obtained after each patient agreed to treatment by written consent.
Conflict-of-interest statement: All authors declare no conflicts-of-interest related to this article.
Data sharing statement: No additional data are available.
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
Corresponding author: Kei Kimura, MD, PhD, Assistant Professor, Division of Lower Gastrointestinal Surgery, Department of Surgery, Hyogo College of Medicine, 1-1 Mukogawa-cho, Nishinomiya, Hyogo 663-8501, Japan. k-kimura@hyo-med.ac.jp
Received: September 27, 2019
Peer-review started: September 27, 2019
First decision: October 18, 2019
Revised: December 8, 2019
Accepted: December 23, 2019
Article in press: December 23, 2019
Published online: March 15, 2020
BACKGROUND
Preoperative chemoradiotherapy regimens using a second drug for locally advanced rectal cancer are still under clinical investigation.
AIM
To investigate the clinical outcomes of patients with locally advanced rectal cancer treated with preoperative chemoradiotherapy using tegafur/gimeracil/oteracil (S-1) plus irinotecan (CPT-11).
METHODS
This was a single-center retrospective study of 82 patients who underwent radical surgery for rectal cancer after chemoradiotherapy with S-1 (80 mg/m2/d), CPT-11 (60 mg/m2/d), and radiation (total 45 Gy) between 2009 and 2016. The median follow-up was 51 mo (range: 17–116 mo).
RESULTS
Twenty-nine patients (35.4%) had T3 or T4 rectal cancer with mesorectal fascia invasion, 36 (43.9%) had extramural vascular invasion, 24 (29.8%) had N2 rectal cancer and eight (9.8%) had lateral lymph node swelling. The relative dose intensity was 90.1% for S-1 and 92.9% for CPT-11. Seventy-nine patients (96.3%) underwent R0 resection. With regard to pathological response, 13 patients (15.9%) had a pathological complete response and 52 (63.4%) a good response (tumor regression grade 2/3). The 5-year local recurrence-free survival, relapse-free survival and overall survival rates were 90.1%, 72.5% and 91.3%, respectively. We analyzed the risk factors for local recurrence-free survival by Cox regression analysis and none were detected. Previously described risk factors such as T4 stage, mesorectal fascia invasion or lateral lymph node swelling were not detected as negative factors for local recurrence-free survival.
CONCLUSION
We demonstrated good compliance and favorable tumor regression in patients with locally advanced rectal cancer treated with preoperative S-1 and CPT-11.
Core tip: Lower advanced rectal cancer located within 8 cm of the anal verge carries a higher risk of local recurrence. The aim of this single-center retrospective study was to assess the clinical outcomes of patients with locally advanced rectal cancer treated preoperative chemoradiotherapy using tegafur/gimeracil/oteracil plus irinotecan. Grade 3 or 4 toxicity was mild and led to good relative dose intensity with on-schedule treatment. Also, we investigated the risk factors for local recurrence-free survival and relapse-free survival. Multivariate analysis detected no factors for local recurrence-free survival. Our study confirmed good compliance and favorable tumor regression.
