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. 2020 Jan 31;15(1):e0228060.
doi: 10.1371/journal.pone.0228060. eCollection 2020.

The impact of early adjuvant chemotherapy in rectal cancer

Gyoung Tae Noh  1 , Jeonghee Han  2 , Min Soo Cho  3 , Hyuk Hur  3 , Kang Young Lee  3 , Nam Kyu Kim  3 , Byung Soh Min  3
Affiliations

The impact of early adjuvant chemotherapy in rectal cancer

Gyoung Tae Noh et al. PLoS One. .

Abstract

Purposes: Although adjuvant chemotherapy (AC) has been established as a standard of treatment for advanced rectal cancer, there is no guideline regarding the timing of AC initiation. In this study, we aimed to evaluate the oncologic outcome of early AC initiation and clarify the ideal time to AC among rectal cancer patients receiving preoperative chemo-radiotherapy (preCRT).

Methods: The medical records of 719 patients who underwent curative resection followed by AC for rectal cancer were analyzed retrospectively. Data distributions were compared according to the calculated cut-off for AC initiation, survival results, and chemotherapy-induced toxicity. Additionally, patients were divided into two groups according to preCRT status and compared with respect to differences in the optimal time to AC.

Results: Overall, a cut-off time point of 20 days after surgery for AC initiation was identified as the optimal interval; this yielded a significant difference in disease-free survival but no significant difference in AC toxicity. In the cut-off analysis of patients treated without preCRT, 19 days was identified as the optimal time to AC. However, for patients treated with preCRT, no significant value affected the survival outcome.

Conclusions: Earlier initiation of AC (within approximately 3 weeks) was associated with better oncological outcomes among patients with rectal cancer. Additionally, the optimal timing of AC was unclear among patients who received preCRT; this might be attributable to an undetermined role of AC after preCRT or the effects of complications such as anastomotic leakage.

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Conflict of interest statement

The authors have declared that no competing interests exist.

Figures

Fig 1
Fig 1. Distribution of the time to adjuvant chemotherapy in 977 patients.
Fig 2
Fig 2. Kaplan–Meier curves for disease-free survival among all the patients (a), patients treated without preoperative chemo-radiotherapy (b), and patients treated with preoperative chemo-radiotherapy (c).
Comparisons of patients who initiated adjuvant chemotherapy within the cut-off point (blue line) and beyond the cut-off point (green line).
See this image and copyright information in PMC

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