title: Adjuvant chemotherapy after neoadjuvant chemoradiation and curative resection for rectal cancer: is it necessary for all patients?
abstract: BACKGROUND
  The benefit of adjuvant chemotherapy for patients with locally advanced rectal cancer who have received neoadjuvant concurrent chemoradiation therapy (CCRT) and undergone curative resection remains unclear.
  
  
  METHODS
  This study was a retrospective review of prospectively collected data. Patients with locally advanced rectal cancer who underwent curative surgery after neoadjuvant CCRT between January 2006 and March 2011 were identified. Four hundred forty-one patients who completed adjuvant chemotherapy (chemo group) were compared with 35 patients who did not receive any adjuvant treatment (nonchemo group).
  
  
  RESULTS
  The 5-year disease-free survival (DFS) was significantly higher in the chemo group (78.5% vs. 63.1%, P =  0.016). After stratification of the patients according to nodal status, these differences were no longer significant, but there were trends toward inferior DFS in the nonchemo group in all survival curves. In multivariate Cox regression analysis, no adjuvant chemotherapy (HR, 2.306; 95% CI, 1.101-4.829; P = 0.027) emerged as an independent prognostic factor associated with decreased DFS.
  
  
  CONCLUSIONS
  Adjuvant chemotherapy was significantly associated with increased DFS among patients who had undergone neoadjuvant CCRT and radical resection for locally advanced rectal cancer. Adjuvant chemotherapy should be considered in every patient after neoadjuvant CCRT irrespective of the final pathology stage.
authors.affiliation: Department of Surgery, Kangbuk Samsung Hospital, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea.
authors.forename: Kyung Uk
authors.initials: KU
authors.lastname: Jung
authors.forename: Hee Cheol
authors.initials: HC
authors.lastname: Kim
authors.forename: Joon Oh
authors.initials: JO
authors.lastname: Park
authors.forename: Young Suk
authors.initials: YS
authors.lastname: Park
authors.forename: Hee Chul
authors.initials: HC
authors.lastname: Park
authors.forename: Doo Ho
authors.initials: DH
authors.lastname: Choi
authors.forename: Yong Beom
authors.initials: YB
authors.lastname: Cho
authors.forename: Seong Hyeon
authors.initials: SH
authors.lastname: Yun
authors.forename: Woo Yong
authors.initials: WY
authors.lastname: Lee
authors.forename: Ho-Kyung
authors.initials: HK
authors.lastname: Chun
mesh_terms: D000230:Adenocarcinoma / Q000401:mortality / Q000473:pathology / Q000628:therapy; D000368:Aged; D059248:Chemoradiotherapy; D017024:Chemotherapy, Adjuvant; D018572:Disease-Free Survival; D005260:Female; D006801:Humans; D053208:Kaplan-Meier Estimate; D008297:Male; D008875:Middle Aged; D020360:Neoadjuvant Therapy; D009364:Neoplasm Recurrence, Local; D011379:Prognosis; D012004:Rectal Neoplasms / Q000401:mortality* / Q000473:pathology / Q000628:therapy*; D056910:Republic of Korea / Q000453:epidemiology; D012189:Retrospective Studies
keywords: neoadjuvant CCRT; postoperative chemotherapy; rectal cancer