TY - JOUR
T1 - Short-Course TNT Improves Rectal Tumor Downstaging in a Retrospective Study of the US Rectal Cancer Consortium
AU - Bauer, Philip S.
AU - Gamboa, Adriana C.
AU - Otegbeye, Ebunoluwa E.
AU - Chapman, William C.
AU - Rivard, Samantha
AU - Regenbogen, Scott
AU - Hrebinko, Katherine A.
AU - Holder-Murray, Jennifer
AU - Wiseman, Jason T.
AU - Ejaz, Aslam
AU - Edwards-Hollingsworth, Kamren
AU - Hawkins, Alexander T.
AU - Hunt, Steven R.
AU - Balch, Glen C.
AU - Wise, Paul E.
N1 - Publisher Copyright:
© 2024 Wiley Periodicals LLC.
PY - 2024
Y1 - 2024
N2 - Background and Objectives: The RAPIDO trial showed promising rates of pathologic complete response (pCR) after neoadjuvant short-course radiation with consolidation chemotherapy (total neoadjuvant therapy [SC TNT]) for rectal cancer. Only single-center reviews comparing tumor downstaging between SC TNT and long-course chemoradiation (LCRT) have been published in the United States. We reviewed our multi-institutional experience with both. Methods: The US Rectal Cancer Consortium database (2007–2018) including data from six high-volume rectal cancer care centers was reviewed. Patients with nonmetastatic, rectal adenocarcinoma who had neoadjuvant LCRT alone or SC TNT before excision or definitive nonoperative management were included. The primary outcome was the rate of complete response (CR), including pCR or durable (12 month) clinical complete response. Results: Of 857 included patients, 175 (20%) received SC TNT and 682 (80%) received LCRT. The LCRT group had more low tumors (51.8% vs. 37.1%, p < 0.0001) and more clinically node-negative disease (31.8% vs. 22.3%, p < 0.0001). The CR rate was higher after SC TNT (34.1% vs. 20.3%, p = 0.0001). SC TNT was a predictor of CR (OR: 2.52, CI: 1.68–3.78). SC TNT patients completing 5–6 months of consolidation chemotherapy had a CR rate of 42.9%. There was no difference in 3-year PFS. Conclusions: SC TNT increases CR rate when compared to LCRT. For patients seeking nonoperative options or fewer radiation treatments, SC TRT should be preferred over LCRT alone.
AB - Background and Objectives: The RAPIDO trial showed promising rates of pathologic complete response (pCR) after neoadjuvant short-course radiation with consolidation chemotherapy (total neoadjuvant therapy [SC TNT]) for rectal cancer. Only single-center reviews comparing tumor downstaging between SC TNT and long-course chemoradiation (LCRT) have been published in the United States. We reviewed our multi-institutional experience with both. Methods: The US Rectal Cancer Consortium database (2007–2018) including data from six high-volume rectal cancer care centers was reviewed. Patients with nonmetastatic, rectal adenocarcinoma who had neoadjuvant LCRT alone or SC TNT before excision or definitive nonoperative management were included. The primary outcome was the rate of complete response (CR), including pCR or durable (12 month) clinical complete response. Results: Of 857 included patients, 175 (20%) received SC TNT and 682 (80%) received LCRT. The LCRT group had more low tumors (51.8% vs. 37.1%, p < 0.0001) and more clinically node-negative disease (31.8% vs. 22.3%, p < 0.0001). The CR rate was higher after SC TNT (34.1% vs. 20.3%, p = 0.0001). SC TNT was a predictor of CR (OR: 2.52, CI: 1.68–3.78). SC TNT patients completing 5–6 months of consolidation chemotherapy had a CR rate of 42.9%. There was no difference in 3-year PFS. Conclusions: SC TNT increases CR rate when compared to LCRT. For patients seeking nonoperative options or fewer radiation treatments, SC TRT should be preferred over LCRT alone.
KW - rectal cancer
KW - short-course radiation
KW - total neoadjuvant therapy
KW - tumor downstaging
KW - watch and wait
UR - http://www.scopus.com/inward/record.url?scp=85206185183&partnerID=8YFLogxK
U2 - 10.1002/jso.27908
DO - 10.1002/jso.27908
M3 - Article
C2 - 39400312
AN - SCOPUS:85206185183
SN - 0022-4790
JO - Journal of surgical oncology
JF - Journal of surgical oncology
ER -