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Postoperative Chemotherapy May Not Be Necessary for Patients With ypN0-Category After Neoadjuvant Chemoradiotherapy of Rectal Cancer

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Diseases of the Colon & Rectum

Purpose

After neoadjuvant radiochemotherapy and surgery, there is no general agreement about whether postoperative chemotherapy is necessary. With the help of clinical and pathohistologic data, prognostic factors were determined as a basis for the decision to spare a patient additional chemotherapy or to urgently recommend it.

Results

Ninety-five patients treated with neoadjuvant 5-fluorouracil-based radiochemotherapy (November 4, 1997 and June 15, 2004) without distant metastases and an R0 (microscopically complete) resection were evaluated. Adjuvant chemotherapy (5-fluorouracil or 5-fluorouracil/folinic acid) was given to 65 of 95 patients (68.4 percent). The disease-free survival rate after 36 months was chosen as the target parameter (median follow-up, 36 months).

Methods

The five-year survival rate for all patients was 80.3 ± 5.6 percent; the five-year disease-free survival was 78.1 ± 5.1 percent; the five-year local control rate was 94.2 ± 5.1 percent. In the univariate and multivariate analysis of the disease-free survival, the pathohistologic lymph node status after radiochemotherapy (ypN) was the only significant prognostic parameter. Disease-free survival (36 months) for patients without lymph node metastases (ypN0) was excellent, independent of whether they had received postoperative chemotherapy (n = 43; 87.5 ± 6.0 percent) or not (n = 29; 87.7 ± 6.7 percent). Patients with ypN2 status have, despite chemotherapy, a poor disease-free survival at 30 ± 17.6 percent after 36 months.

Conclusions

These retrospective data suggest that, for some patients, postoperative chemotherapy can be spared. For patients with ypN2 status, an intensification of the postoperative chemotherapy should be considered. Further evaluation in prospective studies is urgently recommended.

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Acknowledgment

The authors thank Prof. Paul Hermanek, M.D., Erlangen, for his excellent and critical advice during the preparation of this manuscript.

Author information

Authors and Affiliations

  1. Department of Radiotherapy, University Hospital, Rostock, Germany

    Rainer Fietkau M.D., Gunther Klautke M.D. & Ute Küchenmeister M.D.

  2. Department of Pathology, University Hospital, Rostock, Germany

    Malte Barten M.D. & Friedrich Prall M.D.

  3. Department of Surgery, University Hospital, Rostock, Germany

    Ernst Klar M.D.

  4. Department of Surgery, Klinikum Südstadt, Rostock, Germany

    Kaja Ludwig M.D.

  5. Department of Surgery, Klinikum Wismar, Wismar, Germany

    Hartmut Thomas M.D.

  6. Department of Surgery, Klinikum Güstrow, Güstrow, Germany

    Wolfgang Brinckmann M.D.

  7. Department of Surgery, Klinikum Bad Doberan, Bad Doberan, Germany

    Andreas Friedrich M.D.

  8. Department of Haemotology/Oncology, University Hospital, Rostock, Germany

    Gernot Hartung M.D.

  9. Institute of Medical Informatics and Biometry, University Rostock, Rostock, Germany

    Gunther Kundt Ph.D.

  10. Department of Radiotherapy, University of Rostock, Südring 75, 18059, Rostock, Germany

    Rainer Fietkau M.D.

Authors
  1. Rainer Fietkau M.D.
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  2. Malte Barten M.D.
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  3. Gunther Klautke M.D.
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  4. Ernst Klar M.D.
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  5. Kaja Ludwig M.D.
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  6. Hartmut Thomas M.D.
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  7. Wolfgang Brinckmann M.D.
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  8. Andreas Friedrich M.D.
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  9. Friedrich Prall M.D.
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  10. Gernot Hartung M.D.
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  11. Ute Küchenmeister M.D.
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  12. Gunther Kundt Ph.D.
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Corresponding author

Correspondence to Rainer Fietkau M.D..

Additional information

Some Phase II trials of neoadjuvant chemoradiotherapy were supported in part by grants and drugs from Hofmann-La Roche, Grenzach, Germany; Aventis, Bad Soden am Taunus, Germany; and Pfizer, Karlsruhe, Germany.

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Fietkau, R., Barten, M., Klautke, G. et al. Postoperative Chemotherapy May Not Be Necessary for Patients With ypN0-Category After Neoadjuvant Chemoradiotherapy of Rectal Cancer. Dis Colon Rectum 49, 1284–1292 (2006). https://doi.org/10.1007/s10350-006-0570-x

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  • DOI: https://doi.org/10.1007/s10350-006-0570-x

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