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Timing of Adjuvant Chemotherapy and Survival in Patients with Stage II/III Rectal Cancer

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DOI: 10.4236/jct.2012.326122    3,256 Downloads   5,291 Views  

ABSTRACT

Background: Treatment guidelines in the 1990s established surgery followed by chemoradiotherapy as the standard treatment for stage II/III rectal cancer. Our aim was to investigate the association between the timing of adjuvant treatment and patient survival in practice and identify demographic/clinical factors associated with treatment patterns. Methods: All residents of Alberta diagnosed with stage II/III rectal adenocarcinoma in 2000-2005 who had surgery were included in the study. Demographic and clinical data were obtained from the Alberta Cancer Registry and linked to hospital data and socioeconomic data from the 2001 Canadian Census. Overall and cancer-specific hazard ratios of death were estimated using Cox proportional hazards models. Results: 1243 patients were included in the study; 636 (51%) patients received treatment consistent with guidelines. Patients who received adjuvant chemotherapy 12 - 16 weeks after surgery or more than 16 weeks/ did not receive it had a 43% and 58% higher risk of rectal cancer death, respectively, compared to those who received it within 8 weeks of surgery. Conclusion: Adjuvant chemotherapy for stage II/III rectal cancer should be initiated within 12 weeks after surgery to maximize treatment benefits. Efforts to increase the proportion of patients treated within 12 weeks after surgery are needed.

Conflicts of Interest

The authors declare no conflicts of interest.

Cite this paper

I. Lima, Y. Yasui, A. Scarfe and M. Winget, "Timing of Adjuvant Chemotherapy and Survival in Patients with Stage II/III Rectal Cancer," Journal of Cancer Therapy, Vol. 3 No. 6A, 2012, pp. 956-965. doi: 10.4236/jct.2012.326122.

References

[1] The National of Health Consensus Conference, “Adjuvant Therapy for Patients with Colon and Rectal Cancer,” The Journal for American Medical Association, Vol. 264, No. 11, 1990, pp. 1444-1450. doi:10.1001/jama.1990.03450110090034
[2] H. O. Douglass Jr., C. G. Moertel, R. J. Mayer, et al., “Survival after Postoperative Combination Treatment of Rectal Cancer,” The New England Journal of Medicine, Vol. 315, No. 20, 1986, pp. 1294-1295. doi:10.1056/NEJM198611133152014
[3] B. Fisher, N. Wolmark, H. Rockette, et al., “Postoperative Adjuvant Chemotherapy or Radiation Therapy for Rectal Cancer: Results from NSABP Protocol R-01,” Journal of the National Cancer Institute, Vol. 80, No. 1, 1988, pp. 21-29. doi:10.1093/jnci/80.1.21
[4] J. E. Krook, C. G. Moertel, L. L. Gunderson, et al., “Effective Surgical Adjuvant Therapy for High-Risk Rectal Carcinoma,” The New England Journal of Medicine, Vol. 324, No. 11, 1991, pp. 709-715. doi:10.1056/NEJM199103143241101
[5] Colorectal Cancer Collaborative Group, “Adjuvant Radiotherapy for Rectal Cancer: A Systematic Overview of 8507 Patients from 22 Randomized Trials,” The Lancet, Vol. 358, No. 9290, 2001, pp. 1291-1304. doi:10.1016/S0140-6736(01)06409-1
[6] R. Sauer, H. Becker, W. Hohenberger, et al., “Preoperative Versus Postoperative Chemoradiotherapy for Rectal Cancer,” The New England Journal of Medicine, Vol. 351, No. 17, 2004, pp. 1731-1740. doi:10.1056/NEJMoa040694
[7] L. L. Gunderson, D. J. Sargent, J. E. Tepper, et al., “Impact of T and N Stage and Treatment on Survival and Relapse in Adjuvant Rectal Cancer: A Pooled Analysis,” Journal of Clinical Oncology, Vol. 22, No. 10, 2004, pp. 1785-1796. doi:10.1200/JCO.2004.08.173
[8] A. I. Neugut, A. T. Fleischauer, V. Sundararajan, et al., “Use of Adjuvant Chemotherapy and Radiation Therapy for Rectal Cancer among the Elderly: A Population-Based Study,” Journal of Clinical Oncology, Vol. 20, No. 11, 2002, pp. 2643-2650. doi:10.1200/JCO.2002.08.062
[9] J. Folkesson, H. Birgisson, L. Pahlman, et al., “Swedish Rectal Cancer Trial: Long Lasting Benefits from Radiotherapy on Survival and Local Recurrence Rate,” Journal of Clinical Oncology, Vol. 23, No. 24, 2005; pp. 5644-5650. doi:10.1200/JCO.2005.08.144
[10] M. S. Roh, L. H. Colangelo, M. J. O’Connell, et al., “Preoperative Multimodality Therapy Improves Disease-free Survival in Patients with Carcinoma of the Rectum: NSABP R-03,” Journal of Clinical Oncology, Vol. 27, No. 31, 2009, pp. 5124-5130. doi:10.1200/JCO.2009.22.0467
[11] National Comprehensive Cancer Network, “Rectal Cancer V.2. NCCN Clinical Practical Guidelines in Oncology 2010,” 2010. http://www.nccn.org/professionals/physician_gls/PDF/rectal.pdf
[12] B. Glimelius, J. Oliveira and ESMO Guidelines Working Group. “Rectal Cancer: ESMO Clinical Recommendations for Diagnosis, Treatment and Follow-Up,” Annals of Oncology, Vol. 20, No. S4, 2009, pp. 54-56. doi:10.1093/annonc/mdp128
[13] T. C. Tucker, H. L. Howe, and H. K. Weir, “Certification for Population-Based Cancer Registries,” Journal of Registry Management, Vol. 26, No. 1, 1999, pp. 24-27.
[14] A. Fritz, C. Percy, A. Jack, et al. (Eds.), “International Classification of Diseases for Oncology,” World Health Organization, Geneva, 2000. http://www.who.int/classifications/icd/adaptations/oncology/en/index.html
[15] F. L. Greene, D. L. Page, I. D. Fleming, et al. (Eds), “AJCC Cancer Staging Manual 6th Edition,” Springer-Verlag, New York, 2002. http://www.cancerstaging.org/products/ajccproducts.html
[16] World Health Organization, “Statistical Classification of Diseases and Related Health Problems10th Revision. v.2 Instruction Manual,” World Health Organization, Geneva, 1994, pp. 30-85.
[17] H. Quan, V. Sundararajan, P. Halfon, et al., “Coding Algorithms for Fefining Comorbidities in ICD-9-CM and ICD-10 Administrative Data,” Medical Care, Vol. 43, No. 11, 2005, pp. 1130-1139. doi:10.1097/01.mlr.0000182534.19832.83
[18] W. D'Hoore, C. Sicotte and C. Tilquin, “Risk Adjustment in Outcome Assessment: The Charlson Comorbidity Index,” Methods of Information Medicine, Vol. 32, No. 5, 1993, pp. 382-387. http://europepmc.org/abstract/MED/8295545
[19] Lima, Y. Yasui, S. Andrew, et al., “Association between Receipt and Timing of Adjuvant Chemotherapy and Survival for Patients with Stage III Colon Cancer in Alberta, Canada,” Cancer, Vol. 117, No. 16, 2011, pp. 3833-3840. doi:10.1002/cncr.25954
[20] T. A. Gooley, W. Leisenring, J. Crowley, et al., “Estimation of Failure Probabilities in the Presence of Competing Risks: New Representations of Old Estimators,” Statistics in Medicine, Vol. 18, No. 6, 1999, pp. 695-706. doi:10.1002/(SICI)1097-0258(19990330)18:6<695::AID-SIM60>3.0.CO;2-O
[21] S. Durrleman and R. Simon, “Flexible Regression Models with Cubic Splines,” Statistics in Medicine, Vol. 8, No. 5, 1989, pp. 551-561. doi:10.1002/sim.4780080504
[22] R. K. Wong, S. Berry, K. Spithoff, et al., “Preoperative or Postoperative Therapy for Stage II or III Rectal Cancer: An updated Practice Guideline,” Clinical Oncology, Vol. 22, No. 4, 2010, pp. 265-271. http://www.ncbi.nlm.nih.gov/pubmed/20398849
[23] T. J. Iwashyna and E. B. Lamont, “Effectiveness of Adjuvant Fluorouracil in Clinical Practice: A Population-Based Cohort Study of Elderly Patients with Stage III Colon Cancer,” Journal of Clinical Oncology, Vol. 20, No. 19, 2002, pp. 3992-3998. doi:10.1200/JCO.2002.03.083
[24] V. Sundararajan, N. Mitra, J. S. Jacobson, et al., “Survival Associated with 5-Fluorouracil-Based Adjuvant Chemotherapy among Elderly Patients with Node-Positive Colon Cancer,” Annals of International Medicine, Vol. 136, No. 5, 2002, pp. 349-357. http://www.ncbi.nlm.nih.gov/pubmed/11874307
[25] D. J. Sargent, R. M. Goldberg, S. D. Jacobson, et al., “A Pooled Analysis of Adjuvant Chemotherapy for Resected Colon Cancer in Elderly Patients,” The New England Journal of Medicine, Vol. 345, No. 15, 2001, pp. 1091-1097. doi:10.1056/NEJMoa010957
[26] I. H. Zuckerman, T. Rapp, E. Onukwugha, et al., “Effect of Age on Survival Benefit of Adjuvant Chemotherapy in Elderly Patients with Stage III Colon Cancer,” Journal of American Geriatrics Society, Vol. 57, No. 8, 2009, pp. 1403-1410. http://www.ncbi.nlm.nih.gov/pubmed/19563521
[27] M. Winget, S. Hossain, Y. Yasui, et al., “Characteristics of Stage III Colon Adenocarcinoma Patients Who Fail to Receive Guideline-Recommended Treatment,” Cancer, Vol. 116, No. 20, 2010, pp. 4849-4856. doi:10.1002/cncr.25250
[28] J. Z. Ayanian, A. M. Zaslavsky, C. S. Fuchs, et al., “Use of Adjuvant Chemotherapy and Radiation Therapy for Colorectal Cancer in a Population-Based Cohort,” Journal of Clinical Oncology, Vol. 21, No. 7, 2003, pp. 1293-1300. doi:10.1200/JCO.2003.06.178
[29] N. S. Eldin, Y. Yasui, A. Scarfe, et al., “Adherence to Treatment Guidelines in Stage II/III Rectal Cancer in Alberta, Canada,” Clinical Oncology, Vol. 24, No. 1, 2012, pp. e9-e17. doi:10.1016/j.clon.2011.07.005
[30] V. Valentini, C. Aristei, B. Glimelius, et al., “Multidisciplinary Rectal Cancer Management: 2nd European Rectal Cancer Consensus Conference (EURECACC2),” Radiotherapy & Oncology, Vol. 92, No. 2, 2009, pp. 148-163. doi:10.1016/j.radonc.2009.06.027
[31] Alberta Health Services, “Clinical Practice Guideline GI-005: Early Stage Rectal Cancer,” 2010. http://www.albertahealthservices.ca/hp/if-hp-cancer-guide-gi005-early-stage-rectal.pdf
[32] D. Hershman, M. J. Hall, X. Wang, et al., “Timing of Adjuvant Chemotherapy Initiation after Surgery for Stage III Colon Cancer,” Cancer, Vol. 107, No. 11, 2006, pp. 2581-2588. doi:10.1002/cncr.22316

  
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