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The survival impact of preoperative FOLFOX for resectable locally advanced rectal cancer: the R-NAC-01 study

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Abstract

Purpose

In this follow-up of the R-NAC-01 study, we assessed the long-term oncological benefit of four courses of modified leucovorin, 5-fluorouracil (FU), and oxaliplatin (mFOLFOX6) chemotherapy before rectal surgery.

Methods

In this prospective, multicenter study (UMIN 000012559) involving 11 hospitals in Japan, patients with lower rectal cancer underwent four cycles of mFOLFOX6 chemotherapy and subsequent surgery within four to six weeks. The 3-year recurrence-free survival and local recurrence rates were then reported.

Results

Of 41 patients (36 males, 5 females; mean age: 60.8 years old) who received 4 courses of chemotherapy, 40 underwent total mesorectal excision, and 1 underwent total pelvic exenteration. R0 resection was achieved in 40 patients, but none showed a pathological complete response. Twenty-nine patients received adjuvant chemotherapy for an average of 4 months. The 3 year recurrence-free survival and local recurrence rates in patients undergoing curable resection were 72.8% and 8.5%, respectively. cStage III patients with adjuvant chemotherapy had a significantly higher 3 year recurrence-free survival than those without adjuvant chemotherapy (76.6 vs. 40.0%, log-rank p = 0.03).

Conclusion

Four courses of mFOLFOX6 chemotherapy before surgery may be a promising treatment strategy for locally advanced rectal cancer. Adjuvant chemotherapy might be needed for cStage III patients, even after four courses of neoadjuvant mFOLFOX6.

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Acknowledgements

I would like to thank Drs. Keita Noguchi, Daisuke Kuraya, Shiro Nakano, Koichi Taguchi, Makoto Nishikawa, Hayato Echizenya, Shin Emoto, Yoichi Miyaoka, and Hiroki Matsui for their help with data collection and their useful discussion.

Funding

The authors did not receive any specific grant from funding agencies in the public, commercial, or not-for-profit sectors for this research.

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Authors and Affiliations

  1. Department of Gastroenterological Surgery I, Graduate School of Medicine, Hokkaido University, N-15, W-7, Kita-ku, Sapporo, 060-8638, Japan

    Nobuki Ichikawa, Shigenori Homma, Hiroaki Iijima, Tadashi Yoshida, Nozomi Minagawa, Norihiko Takahashi & Akinobu Taketomi

  2. Department of Surgery, Asahikawa-Kosei General Hospital, 1 jo-dori, 24 choume-111, Asahikawa, 078-8211, Japan

    Tohru Funakoshi

  3. Department of Surgery, Sapporo Hokuyu Hospital, 6 choume 5-1, Higasi-sapporo, Sapporo, 003-0006, Japan

    Masahiro Hattori & Masanori Sato

  4. Department of Surgery, Iwamizawa Municipal Hospital, West 7-2, 9 jou, Iwamizawa, 068-8555, Japan

    You Kamiizumi

  5. Department of Surgery, Keiwakai Ebetsu Hospita, Yoyogi-cho 81-6, Ebetsu, 069-0817, Japan

    Kazuyoshi Omori & Masaru Nomura

  6. Department of Surgery, Sunagawa City Medical Center, W-4, N-3-1-1, Sunagawa, 073-0196, Japan

    Ryoichi Yokota

  7. Department of Surgery, KKR Sapporo Medical Center, Hiragishi 1-6-3-40, Toyohira-ku, Sapporo, 062-0931, Japan

    Masahiko Koike, Hirofumi Kon & Keisa Takeda

  8. Department of Surgery, Sapporo-Kosei General Hospital, N-3, E-8-5, Chuo-ku, Sapporo, 060-0033, Japan

    Hiroyuki Ishizu

  9. Department of Surgery, Tomakomai City Hospital, Shimizu-chou 1-5-20, Tomakomai, 053-8567, Japan

    Shinichi Matsuoka & Kunihiro Hirose

  10. Department of Surgery, Abashiri-Kosei General Hospital, N-6, W-1-9, Abashiri, 093-0076, Japan

    Takahisa Ishikawa

  11. Department of Surgery, Otaru General Hospital, Wakamatsu-chou 1-1-1, Otaru, 047-8550, Japan

    Ryohei Murata

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  1. Nobuki Ichikawa
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  2. Shigenori Homma
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Correspondence to Shigenori Homma.

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Ichikawa, N., Homma, S., Funakoshi, T. et al. The survival impact of preoperative FOLFOX for resectable locally advanced rectal cancer: the R-NAC-01 study. Surg Today 52, 1134–1142 (2022). https://doi.org/10.1007/s00595-021-02447-7

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