Research progress in neoadjuvant chemoradiotherapy for advanced rectal cancer

doi:10.3877/cma.j.issn.2095-3224.2020.02.014

Abstract

Abstract:

The incidence and death rate of colorectal cancer are very high in China. The incidence and local recurrence rate of rectal cancer are usually higher than that of colon cancer. And the operation is difficult. At present, to prevent the local recurrence of rectal cancer, multidisciplinary treatment is widely used. Neoadjuvant chemoradiotherapy (nCRT), as a developing multidisciplinary method, can not only guarantee the curative effect but also maintain the organ function, and plays a crucial role in the treatment of rectal cancer. The purpose of this review is to clarify the current situation and future improvement direction of nCRT.

Key words: Rectal neoplasms, Advanced rectal cancer, Neoadjuvant chemotherapy, Neoadjuvant radiotherapy, Neoadjuvant chemoradiotherapy, Local recurrence rate

Qianmin Gao, Xintao Chen, Houshan Yao, Zhiqian Hu. Research progress in neoadjuvant chemoradiotherapy for advanced rectal cancer[J]. Chinese Journal of Colorectal Diseases(Electronic Edition), 2020, 09(02): 188-195.

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Figures/Tables 5

References 54

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项目		XELOX＋Cap/RT＋XELOX	XELOX＋XELOX/RT＋XELOX^［27］	FOLFOX/Bev＋Bev/5-FU/RT＋FOLFOX^［28］
完成新辅助治疗病例数		38	48	25
3~4级不良反应事件		?	?	?
?	血液系统	10.5%（4/38）	12.2%（6/49）	72%（18/25）
?	非血液系统	13.2%（5/38）	18.4%（9/49）	48%（12/25）
pCR率		28.9%（11/38）	42.2%（19/45）	36%（9/25）
保肛率		52.6%（20/38）	73.3%（33/45）	80%（20/25）
术后并发症发生率		10.5%（4/38）	11.1%（5/45）	20%（5/25）

项目		XELOX＋Cap/RT＋XELOX	XELOX＋XELOX/RT＋XELOX^［27］	FOLFOX/Bev＋Bev/5-FU/RT＋FOLFOX^［28］
完成新辅助治疗病例数		38	48	25
3~4级不良反应事件		?	?	?
?	血液系统	10.5%（4/38）	12.2%（6/49）	72%（18/25）
?	非血液系统	13.2%（5/38）	18.4%（9/49）	48%（12/25）
pCR率		28.9%（11/38）	42.2%（19/45）	36%（9/25）
保肛率		52.6%（20/38）	73.3%（33/45）	80%（20/25）
术后并发症发生率		10.5%（4/38）	11.1%（5/45）	20%（5/25）

实验名称	实验年份	患者数量	试验方案	实验终点	中位随访时间（年）	OS（%）	DFS（%）
STAR-01^［30］	2011	379	5-FU	OS，PCR	-	-	-
STAR-01^［30］	2011	368	5-FU＋OX	?	?	-	-
ACCORD 12^［31,32］	2012	299	Cape	pCR	>5	70.8	66.1
ACCORD 12^［31,32］	2012	299	Cape＋OX	?	?	72.9（HR 0.90，P=0.5）	63.1（ HR 0.86，P=0.3）
CAO/ARO/AIO-04^［33］	2012，2015	623	5-FU	DFS	>3	88.0	71.2
CAO/ARO/AIO-04^［33］	2012，2015	613	5-FU＋OX	?	?	88.7（HR 0.96，CI 0.72~1.26）	75.3（HR 0.79，CI 0.64~0.98）
NSABP R-04^［34］	2014，2015	949	5-FU/Cape	手术失败行保肛手术	>3	79.0	64.2
NSABP R-04^［34］	2014，2015	659	5-FU/Cape＋OX	?	?	81.3（HR 0.89，P=0.38）	69.2（HR 0.91，P=0.34）
PETACC-6^［35］	2014，2018	623	Cape	DFS	>3	83.1	71.3
PETACC-6^［35］	2014，2018	613	Cape＋OX	?	?	80.1（HR 1.17，P=0.25）	70.5（HR 1.02，P=0.84）
JIAO 2015^［36］	2015	103	Cape	DFS，OS	>3	86.4	70
JIAO 2015^［36］	2015	103	Cape＋OX	?	?	90.3（P=0.5155）	80.6（P=0.076）
FOWARC^［37］	2016，2018	155→130	5-FU	DFS	>3	76.4±3.8	93.7±2.2
FOWARC^［37］	2016，2018	158→142	5-FU＋OX	?	?	77.8±3.5	92.0±2.3
实验名称	LRR（%）	转移率（%）	pCR率（%）	3~4级毒性率（%）	保肛手术率（%）	奥沙利铂组术前化放疗依从性（%）
STAR-01^［30］	6.0	2.9（腹腔）	16.4	8.0（P<0.001）	80.6	-
STAR-01^［30］	1.3	0.5	16.8（P=0.904）	25.4	81.7	66.0
ACCORD 12^［31,32］	8.8	4.2（腹腔）	13.9（P<0.001）	10.9（P<0.001）	-	-
ACCORD 12^［31,32］	7.8（HR=0.92，P=0.7）	2.8	19.2	25.4	-	41.0
CAO/ARO/AIO-04^［33］	4.6	6.0	13.0	13.0	88.0	-
CAO/ARO/AIO-04^［33］	2.9	4.0（全部）	17.0（P =0.04）	17.0（P=0.04）	88.0	85.0
NSABP R-04^［34］	12.1	-	17.8	6.6	62.0	-
NSABP R-04^［34］	11.2（P=0.7）	-	19.5（P=0.42）	15.4（P<0.0001）	62（ P =0.28）	-
PETACC-6^［35］	-	-	11.3	15.2	70.0	-
PETACC-6^［35］	-	-	13.3	36.7	65.1（ P =0.09）	-
JIAO 2015^［36］	5.8	28.2	23.3	6.8	77.7	-
JIAO 2015^［36］	4.9（ P =0.7）	16.5（P=0.045）	19.4（P=0.479）	16.5（P=0.03）	84.5	81.6
FOWARC^［37］	10.0	-	14.0	10.7	84.4	-
FOWARC^［37］	8.5	-	27.5（P=0.05）	21.3（P=0.037）	87.2	94.9

实验名称	实验年份	患者数量	试验方案	实验终点	中位随访时间（年）	OS（%）	DFS（%）
STAR-01^［30］	2011	379	5-FU	OS，PCR	-	-	-
STAR-01^［30］	2011	368	5-FU＋OX	?	?	-	-
ACCORD 12^［31,32］	2012	299	Cape	pCR	>5	70.8	66.1
ACCORD 12^［31,32］	2012	299	Cape＋OX	?	?	72.9（HR 0.90，P=0.5）	63.1（ HR 0.86，P=0.3）
CAO/ARO/AIO-04^［33］	2012，2015	623	5-FU	DFS	>3	88.0	71.2
CAO/ARO/AIO-04^［33］	2012，2015	613	5-FU＋OX	?	?	88.7（HR 0.96，CI 0.72~1.26）	75.3（HR 0.79，CI 0.64~0.98）
NSABP R-04^［34］	2014，2015	949	5-FU/Cape	手术失败行保肛手术	>3	79.0	64.2
NSABP R-04^［34］	2014，2015	659	5-FU/Cape＋OX	?	?	81.3（HR 0.89，P=0.38）	69.2（HR 0.91，P=0.34）
PETACC-6^［35］	2014，2018	623	Cape	DFS	>3	83.1	71.3
PETACC-6^［35］	2014，2018	613	Cape＋OX	?	?	80.1（HR 1.17，P=0.25）	70.5（HR 1.02，P=0.84）
JIAO 2015^［36］	2015	103	Cape	DFS，OS	>3	86.4	70
JIAO 2015^［36］	2015	103	Cape＋OX	?	?	90.3（P=0.5155）	80.6（P=0.076）
FOWARC^［37］	2016，2018	155→130	5-FU	DFS	>3	76.4±3.8	93.7±2.2
FOWARC^［37］	2016，2018	158→142	5-FU＋OX	?	?	77.8±3.5	92.0±2.3
实验名称	LRR（%）	转移率（%）	pCR率（%）	3~4级毒性率（%）	保肛手术率（%）	奥沙利铂组术前化放疗依从性（%）
STAR-01^［30］	6.0	2.9（腹腔）	16.4	8.0（P<0.001）	80.6	-
STAR-01^［30］	1.3	0.5	16.8（P=0.904）	25.4	81.7	66.0
ACCORD 12^［31,32］	8.8	4.2（腹腔）	13.9（P<0.001）	10.9（P<0.001）	-	-
ACCORD 12^［31,32］	7.8（HR=0.92，P=0.7）	2.8	19.2	25.4	-	41.0
CAO/ARO/AIO-04^［33］	4.6	6.0	13.0	13.0	88.0	-
CAO/ARO/AIO-04^［33］	2.9	4.0（全部）	17.0（P =0.04）	17.0（P=0.04）	88.0	85.0
NSABP R-04^［34］	12.1	-	17.8	6.6	62.0	-
NSABP R-04^［34］	11.2（P=0.7）	-	19.5（P=0.42）	15.4（P<0.0001）	62（ P =0.28）	-
PETACC-6^［35］	-	-	11.3	15.2	70.0	-
PETACC-6^［35］	-	-	13.3	36.7	65.1（ P =0.09）	-
JIAO 2015^［36］	5.8	28.2	23.3	6.8	77.7	-
JIAO 2015^［36］	4.9（ P =0.7）	16.5（P=0.045）	19.4（P=0.479）	16.5（P=0.03）	84.5	81.6
FOWARC^［37］	10.0	-	14.0	10.7	84.4	-
FOWARC^［37］	8.5	-	27.5（P=0.05）	21.3（P=0.037）	87.2	94.9

临床试验	患者数量	试验方案	试验终点	PFS（%）/中位PFS（月）	OS（%）/中位OS（月）	ORR（%）	3~4级毒性率（%）
SWOG 0713^［38］	75	wCAPOX＋C	pCR	72%	?	?	-
EXPERT-C^［39］	44	CAPOX＋C	CR	-	?	51	-
EXPERT-C^［39］	46	?	?	?	?	71（P=0.38）	?
OPUS^［40］	170	FOLFOX4＋C	pCR	8.3	22.8	57	-
OPUS^［40］	168	FOLFOX4	?	7.2（HR=0.567，P=0.0064）	18.5（HR=0.855，P=0.39）	34（P=0.0027）	?
COIN^［41］	815	mFOLFOX6/XELOX＋C	OS	8.6	17	64	-
COIN^［41］	815	mFOLFOX6/XELOX	?	8.6（HR=0.96，P=0.60）	17.9（HR=1.04，P=0.67）	57（P=0.049）	?
NORDIC-7^［42］	498	Nordic FLOX＋C	pCR	7.9	20.1	46	-
NORDIC-7^［42］	303	Nordic FLOX	?	8.7（HR=1.07，P=0.66）	22（HR=1.14，P=0.48）	47（P=0.89）	?
TAILOR^［43］	192	FOLFOX4＋C	pCR	9.2	20.7	?	16.2
TAILOR^［43］	200	FOLFOX4	?	7.4（HR=0.69，P=0.004）	17.8（HR=0.76，P=0.02）	?	7.3

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