Neoadjuvant Chemoradiotherapy Plus Neoadjuvant Chemotherapy For Locally Advanced Rectal Cancer:Retrospective Analysis Of Efficacy And Safety

Objective: To investigate the efficacy and safety of neoadjuvant chemotherapy(NAC)in patients with locally advanced rectal cancer(LARC)after neoadjuvant chemoradiotherapy(NCRT)to the waiting period of surgery,including pathological complete response(pCR)rate,tumor downstaging rate,R0 resection rate,local recurrence(LR),disease-free survival(DFS),overall survival(OS),postoperative complications,side effects after radiotherapy and chemotherapy.Methods: A total of 47 cases of clinical and follow-up data were collected from January2013 to January 2017 in Shengjing Hospital Affiliated to China Medical University and patients with locally advanced(cT3-4/N+,M0)rectal cancer.After NCRT(radiotherapy+ capecitabine),2-3 cycles of NAC were performed.The chemotherapy regimen was performed in one of the following two ways:(1)XELOX protocol: oxaliplatin +capecitabine,2 cycles;(2)mFOLFOX6 protocol: Oxaliplatin + calcium folic acid +fluorouracil,3 cycles;Total mesorectal excision(TME)is performed 5-12 weeks after the end of NCRT.Regardless of postoperative pathology,follow-up is performed 3-4weeks after operation Adjuvant chemotherapy to complement the entire course of adjuvant chemotherapy for half a year.All patients signed an informed consent form before each treatment.Statistical analysis was performed using SPSS 25.0 、 SAS 9.4statistical software.Results: All patients in the group successfully completed the above treatment,the pCR rate was 25.5%,the T decline rate was 61.7%,the N decline rate was 42.6%,and the anus preservation rate was 68.1%;The median follow-up time was 44.3 months,the3-year cumulative LR rate was 4.3%,the DFS rate was 78.7%,and the OS rate was89.4%;the incidence of postoperative complications was 8.5%;the incidence of grade 3hematological toxicity was 21.3%,and the grade 3 non-hematological toxicity was27.6%.Conclusions:After LARC patients received NCRT + NAC + TME + adjuvant chemotherapy,they had a higher pCR rate(25.5%),a stage decline rate(T stage61.7%%,N stage 42.6%)and a satisfactory R0 resection rate(100%);the 3-year cumulative LR rates is lower(4.3%),the DFS rate(78.7%)and the OS rate(89.4%)is slightly higher;atthe same time,no side effects caused by it and patient intolerance caused by postoperative complications are found,which has good safety.Therefore,we believe that NAC is feasible and has a better short-term effect,which may improve DFS,reduce LR and have a good effect on improving OS;the degree of tumor regression may be the influencing factor of LR,DFS and OS.Because this study is a single-group retrospective analysis and the sample size is limited,the follow-up time is short,and it needs to be confirmed by a clinical phase III prospective study.