586P - Does the compliance to adjuvant chemotherapy depend on neoadjuvant radiation therapy modality?

Date 01 October 2012
Event ESMO Congress 2012
Session Poster presentation III
Topics Anti-Cancer Agents & Biologic Therapy
Rectal Cancer
Surgery and/or Radiotherapy of Cancer
Presenter Kenjey Chan
Authors K. Chan1, T. Vuong2, P. Kavan2, T. Niazi2, C. Holcroft3, E. Ferland4, J. Sturgeon2, D. Melnychuk2, T. Alcindor2, G. Batist5
  • 1Medicine, McGill University, H9J3N5 - Montreal/CA
  • 2Oncology, McGill University, Montreal/CA
  • 3Clinical Epidemiology, McGill University, Montreal/CA
  • 4Oncology, Pierre Boucher Hospital, Longueuil/CA
  • 5Oncology, Mcgill University, McGill University, Montreal/CA

Abstract

One of the standard approach for the locally advanced rectal cancer patients is neoadjuvant chemoradiation therapy (CRT), followed by total mesorectal excision (TME) and adjuvant chemotherapy (ACT). ACT compliance has been a major concern for these patients. In this study we assessed the possible impact of neoadjuvant radiation therapy (RT) modality on ACT compliance.

Methods

We, retrospectively, analyzed the data of 114 locally advanced rectal cancer patients, after neoadjuvant RT and referred for consideration of ACT, at McGill University hospitals. ACT compliance was defined as pts who received at least 6 cycles of ACT and optimal dose compliance (ODC) was defined as pts who received at least 85% of the recommended chemotherapy dose. Neoadjuvant RT modalities included high dose rate endorectal brachytherapy (HDREBT) alone with no chemotherapy; conformal external beam RT (3D-CRT) with chemotherapy and intensity-modulated RT (IMRT) with chemotherapy. We applied a chi-square test for 2-way categorical associations and multivariable logistic regression with compliance as the outcome.

Results

The data of 114 consecutive locally advanced rectal cancer patients, mean age 64y (range:32-85), were analyzed. 41 patients (36%) were treated with neoadjuvant HDREBT alone, 33 (29%) with 3D-CRT and chemotherapy, and 40 (35%) with IMRT and chemotherapy. The HDREBT dose was 26 Gy in 4 consecutive fractions alone and that of 3D-CRT and IMRT was 50 Gy in 25 fractions, Monday to Friday with concurrent 5-FU. 41 pts (36%) received FOLFOX, 13 (11%) XELOX, 11 (10%) 5-FU, 7 (6%) Xeloda and 9 (8%) received other chemotherapy, while 33 pts refused the ACT. ACT compliance after HDREBT, 3D-CRT and IMRT were respectively: 70.7%, 45.5%, 37.5% (p = 0.008). Age was a negative factor (p < 0.001) but not gender (p = 0.61) on ACT compliance. In a multivariate analysis and adjusting for age and gender, HDREBT continued to lead to better ACT compliance compared to 3D-CRT (p = 0.020) and IMRT (p < 0.001) and there was no difference clinically between EBRT and IMRT. Similarly, ODC rate for HDREBT, 3D-CRT and IMRT were respectively: 63.4%, 21.2% and 32.5% (p = 0.001).

Conclusion

Our data suggests that neoadjuvant HDREBT yields significantly higher rates of ACT compliance and ODC compared to 3D-CRT with chemotherapy and IMRT with chemotherapy.

Disclosure

All authors have declared no conflicts of interest.