Impact of total neoadjuvant therapy (TNT) on overall complete response (CR) for locally advanced rectal cancer (LARC): A Brazilian real-world study.
Abstract
54 Background: There are limited data on the impact of TNT on complete response (CR) rates for LARC treated in community settings. Methods: A retrospective cohort study was conducted at two health centers, from January 2019 to August 2023. All consecutive patients with LARC staged cT3-cT4 and/or lymph node- positive (AJCC 8th Edition) who received at least one application of neoadjuvant therapy (NAT)—radiotherapy and/or chemotherapy—were included. The primary outcome was the overall CR rate, stratified by NAT: TNT versus Non-TNT. CR was defined as cases achieving pathological complete response (ypCR) or sustained complete clinical response (cCR) after 12 months for patients undergoing a watchful waiting protocol. Secondary endpoints were ypCR rates and clinical/ hematological toxicities (CTCAE version 5.0) stratified by NAT. Results: Overall, 137 patients were included, with 60 (43.8%) receiving TNT and 77 (56.2%) receiving Non- TNT. The median age was 58.9 years [standard deviation (SD): ±11.2] for the TNT group and 59.0 years (SD: ±11.0) for the Non-TNT group. Initial staging for the TNT and Non-TNT groups was as follows: cT3 (61.6% and 67.5%), cT4 (18.3% and 16.8%), and positive lymph nodes (68.3% and 66.2%), respectively. The median distance from the anal verge was 5.5 cm [Interquartile range (IQR): 5–9.5] for TNT and 6.0 cm (IQR: 5–10) for Non-TNT. The overall CR rates for the TNT and Non-TNT groups were 28.3% (17/60) and 11.6% (9/77), respectively [Odds ratio (OR) = 2.98; 95% CI: 1.24–7.17]. The ypCR rates were 20.0% (12/60) for TNT and 7.8% (6/77) for Non- TNT (OR = 2.96; 95% CI: 1.07–8.14). Grade ≥3 clinical toxicities during NAT occurred in 5.0% (3/60) of the TNT group and 6.4% (5/77) of the Non-TNT group (OR = 0.76; 95% CI: 0.19–3.01). Grade ≥3 hematological toxicities during NAT occurred in 3.3% (2/60) of the TNT group and 5.2% (4/77) of the Non-TNT group (OR = 0.62; 95% CI: 0.11–3.49). Conclusions: The data suggest a higher CR rate in the TNT group compared to the Non-TNT group among patients with LARC treated in community settings.
Article Details
Journal Info
Journal of Clinical Oncology
Lippincott Williams & Wilkins
Authors (20)
Mônica Kalile
Programa de Pós-Graduação em Pesquisa Clínica e Translacional- Fundação Oswaldo Cruz (FIOCRUZ)- Instituto Gonçalo Muniz, Departamento de Oncologia Clínica, Grupo Oncoclínicas Bahia, Hospital Santa Izabel- Santa Casa de Misericórdia da Bahia, Salvador, Brazil
Ramon Mendes
Departamento de Coloproctologia, Hospital Santa Izabel- Santa Casa de Misericórdia da Bahia, Salvador, Brazil
Marco Antonio Oliveira Lessa
Departamento de Oncologia Clínica, Grupo Oncoclínicas Bahia, Hospital Santa Izabel- Santa Casa de Misericórdia da Bahia, Salvador, Brazil
Gabriela Alban
Departamento de Radioterapia, Grupo Oncoclínicas Bahia, Hospital Santa Izabel- Santa Casa de Misericórdia da Bahia, Salvador, Brazil
Maria Cecilia Mathias
Instituto do Câncer do Estado de São Paulo (ICESP), Universidade de São Paulo and Grupo Oncoclinicas, São Paulo, Brazil
Mirela Souto
Departamento de Oncologia Clínica, Grupo Oncoclínicas Bahia, Hospital Santa Izabel- Santa Casa de Misericórdia da Bahia, Salvador, Brazil
Carlos Frederico Benevides
Departamento de Oncologia Clínica, Grupo Oncoclínicas Bahia, Salvador, Brazil
Leonardo Boente
Departamento de Oncologia Clínica, Grupo Oncoclínicas Bahia, Salvador, Brazil
Audrey Cabral
Departamento de Oncologia Clínica, Grupo Oncoclínicas Bahia, Salvador, Brazil
Renata Gondim Meira Velame Azevedo
Departamento de Oncologia Clínica, Grupo Oncoclínicas Bahia, Salvador, Brazil
Thiago Francischetto
Departamento de Cirurgia Oncológica, Grupo Oncoclínicas Bahia, Hospital Santa Izabel- Santa Casa de Misericórdia da Bahia, Salvador, Brazil
Matheus Villa
Departamento de Cirurgia Oncológica, Grupo Oncoclínicas Bahia, Hospital Santa Izabel- Santa Casa de Misericórdia da Bahia, Salvador, Brazil
Meyline Andrade
Departamento de Coloproctologia, Hospital Santa Izabel- Santa Casa de Misericórdia da Bahia, Salvador, Brazil
Joana Pessoa
Departamento de Coloproctologia, Hospital Santa Izabel- Santa Casa de Misericórdia da Bahia, Salvador, Brazil
Tassia Franco
Departamento de Coloproctologia, Hospital Santa Izabel- Santa Casa de Misericórdia da Bahia, Salvador, Brazil
Amanda Ferreira
Departamento de Coloproctologia, Hospital Santa Izabel- Santa Casa de Misericórdia da Bahia, Salvador, Brazil
Carlos Antonio de Souza Teles Santos
Centro de Integração de Dados e Conhecimentos para Saúde (Cidacs), Fundação Oswaldo Cruz (FIOCRUZ)- Instituto Gonçalo Muniz, Salvador, Brazil
Clarissa Mathias
Oncoclínicas&Co and Hospital Santa Izabel, Salvador, Brazil
Eduardo Moraes
Departamento de Oncologia Clínica, Grupo Oncoclínicas Bahia, Hospital Santa Izabel- Santa Casa de Misericórdia da Bahia, Salvador, Brazil
Bruno Mendonça Protásio
Departamento de Oncologia Clínica, Grupo Oncoclínicas Bahia, Hospital Santa Izabel- Santa Casa de Misericórdia da Bahia, Salvador, Brazil