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Adjuvant Chemotherapy

Chapter

Abstract

Adjuvant chemotherapy in the treatment of rectal cancer is controversial. While current guidelines recommend adjuvant chemotherapy following TME, the benefit in the setting of neoadjuvant chemoradiation may be limited. Recommended regimens include single-agent fluoropyrimidines and an oxaliplatin combination regimen with either with infusional fluoropyrimidine (FOLFOX) or capecitabine (CAPEOX). Assumptions that the benefits noted in large colon cancer adjuvant studies are translatable to the treatment of patients with rectal cancer may or may not be justified. Other agents commonly used in metastatic colorectal cancer, including irinotecan, bevacizumab, and cetuximab, have not been shown beneficial in the adjuvant setting in colorectal cancer. Longer time to the initiation of adjuvant chemotherapy appears to result in worse survival. Patients with a pathologic complete response to neoadjuvant chemoradiation may not benefit from adjuvant chemotherapy, whereas partial responders appear to have better outcomes. Further trials are necessary to answer important questions in rectal cancer adjuvant chemotherapy—including whether oxaliplatin improves outcomes, if neoadjuvant chemotherapy would improve compliance and outcomes in rectal cancer.

Keywords

Adjuvant Chemotherapy Rectal cancer 

Abbreviations

95% CI

95% confidence interval

aCT

Adjuvant chemotherapy

CRT

Chemoradiation therapy

DFS

Disease-free survival

HR

Hazard ratio

OS

Overall survival

pCR

Pathologic complete response

TME

Total mesorectal excision

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Copyright information

© Springer Japan 2018

Authors and Affiliations

  1. 1.Lankenau Medical CenterWynnewoodUSA
  2. 2.Division of Medical OncologyThe Ohio State University James Comprehensive Cancer Center and Solove Research InstituteColumbusUSA

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