Induction chemotherapy in locally recurrent rectal cancer 27 CHAPTER 2 Figure 2. Kaplan–Meier curve for overall survival in all resected patients based on pathological outcome. D. M. G. I. van Zoggel, S. J. Bosman, M. Kusters, G. A. P. Nieuwenhuijzen, J. S. Cnossen, G. J. Creemerset al. mine differences from R0 resections with and within survival curves. al analysis are individual variables, t tests and χ2 tests were en appropriate. OS for resected patients was cals the time interval between the date of resection currence and the date of last follow-up or death. as calculated as the time interval between the date ence resection and the date of histological or eviological presence of a local rerecurrence. MFS was d as the time interval between the date of recurection and the date of histological or evident radipresence of distant metastasis. OS, LRFS andMFS mated using the Kaplan–Meier method, with difassessed with the log rank test. cal analysis was performed using SPSS ® version indows ® (IBM, Armonk, New York, USA). Samalculations were done with Power and Precision™ 1 2012 (Biostat, Englewood, New Jersey, USA). he selected time frame, ICT was incorporated multimodality management of 58 patients, and nts received concurrent CRRT alone. Patient and ant treatment characteristics are shown inTable 1. om sex differences, there were no significantly characteristics between the two groups. eral, local recurrences occurred within the first fter resection of the primary tumour, with a interval of 32 (range 5–201) months for first ces and of 17 (range 8–52) months between preurrence surgery and index surgery for second and urrences. Of the 58 patients in the ICT group, red a dose reduction during ICT and six during RRT. Four patients in this group were hospitalng ICT, and one patient during CRRT. In the nly group, one patient required dose reduction, had to be hospitalized. Postoperative compliClavien–Dindo grade III–IV) were comparable groups: 13 (22 per cent) in the ICT group and 19 ent) in the CRRT group (P=0⋅715). argin and pathological complete response who received ICT had a similar R0 resection rate who had CRRT alone (55versus 49 per cent respec- =0⋅506), but exhibited a significantly increased e (17 versus 4 per cent; P=0⋅015) (Table 2). The 0·2 0 0·4 Overall survival 0·6 0·8 1·0 6 12 18 Time after surgery (months) No. at risk 24 30 36 pCR 13 12 6 5 4 2 1 R0, no pCR 54 47 34 28 20 14 13 R1/R2 62 45 35 28 20 15 10 pCR R0, no pCR R1/R2 Fig. 2 Kaplan–Meier curve for overall survival in all resected patients based on pathological outcome. pCR, pathological complete response; RO, complete resection; R1/R2, microscopic/macroscopic tumour present in the resection margin. P=0⋅012 (log rank test) remaining 26 patients in the ICT arm had 23 R1 and three R2 resections, and the 36 remaining in the CRRT-alone arm all had an R1 resection. Overall survival The 3-year OS rate for the 129 patients was 44 per cent (median survival 27months), 92 per cent in patients who had a pCR, 54 per cent in those with an R0 resection but no pCR, and 32 per cent in patients who had an R1/R2 resection (P=0⋅012) (Fig. 2). In the ICT group, patients who had a pCR were all alive at the end of follow-up, whereas those with R0 but no pCR or margin-positive patients had a median survival of 23months (P=0⋅039). There were only three R2 resections in the ICT group, and none in the CRRT group; therefore, no separate analyses for resection state were performed. In the CRRT group, only three patients achieved a pCR, so the numbers were too small to perform statistical comparisons; however, one patient with a pCR died from another cause at 10months. Local and distant recurrence The 3-year LRFS rate was 41 per cent (median survival 20months), 89 per cent at 24months in patients who had a pCR, 65 per cent in those with R0 but no pCR, and 25 per cent for patients with an R1/R2 resection (P<0⋅001). The 3-year MFS rate was 45 per cent (median survival 28months), 60 per cent in patients who had a pCR, 60 per Society Ltd www.bjs.co.uk BJS2018; 105: 447–452 y John Wiley & Sons Ltd pCRpathological complete response; R0 complete r section; R1/R2microscopic/macroscopic tumour pr sent in the resection margin. P = 0.012 (log rank test). Local and distant recur ence The 3-year LRFS rate was 41 percent (median survival 20 months), 89 percent at 24 months in patients who had a pCR, 65 percent in those with R0 but no pCR, and 25 p rcent for patients with an R1/R2 resection (P < 0.001). The 3-year MFS rate was 45 percent (median survival 28 months), 60 percent for R0 but no pCR, and 25 percent for patients with an R1/R2 resection (P = 0.010). Supplemental file Table S1. Types of chemotherapy and treatment regimens for induction chemotherapy Type of chemotherapy Induction + consolidation Induction Full-course chemotherapy before CRRT Total CAPOX 10 19 8 37 (64) FOLFOX 0 2 4 6 (10) CAPOX + Avastin 2 3 1 6 (10) FOLFIRI 1 1 0 2 (3) CAPOX switch to FOLFOX 0 0 1 (2) Other 0 4 2 6 (10) Total 13 (22) 30 (52) 15 (26) 58 Values in parentheses are percentages.
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