title: Surgical outcomes of post chemoradiotherapy unresectable locally advanced rectal cancers improve with interim chemotherapy, is FOLFIRINOX better than CAPOX?
abstract: BACKGROUND
  Role of chemotherapy in patients who continue to have unresectable disease after pre-operative chemo-radiotherapy (CRT) remains largely unaddressed.
  
  
  METHODS
  Patients with LA rectal cancer from January 2013 to June 2015 were evaluated. Post-CRT, patients, who were deemed unresectable, were considered for further interim chemotherapy (i-CT).
  
  
  RESULTS
  Seventy six patients (15%) with median age of 38.5 years received i-CT after CRT. About 61.8% patients receiving i-CT managed to undergo a definitive surgery and the extent of surgery was reduced in 48.7% patients. With the median follow up of 19 months, the estimated 2-year event free survival (EFS) of 48% and OS was 56%. The estimated 2-year OS was 81% in mucinous tumors whereas it was 44.4% in signet ring pathology (P=0.045). The 2-year OS of 86% for whom surgery was donevs.38% (2-year OS) in whom surgery was not done (P=0.011). Survival was better in conservative surgery groupvs. total pelvic exenteration (TPE)vs.no surgery (2-year OS: 84%vs. 59.1%vs. 38%; P=0.033). In the CAPE-OX group, 71.4% (14/23) underwent surgery whereas 75.9% (29/47) in the 5-FU plus irinotecan plus oxaliplatin (FOLFIRINOX) group with EFS (P=0.570) and OS (P=0.120). In conservative surgery group, OS was better in FOLFIRINOX (2-year OS: 95.7%)vs. capecitabine plus oxaliplatin (CAPOX) (2-year OS: 70%) (P=0.012).
  
  
  CONCLUSIONS
  i-CT can lead to improved resection rates, improved survivals and downstaging with acceptable toxicity. FOLFIRINOX appears to better over CAPOX, specifically in whom conservative surgery is feasible.
authors.affiliation: Department of Medical Oncology, TMH, Mumbai 400012, India.
authors.forename: Vikas
authors.initials: V
authors.lastname: Ostwal
authors.affiliation: Department of Radiation Oncology, TMH, Mumbai 400012, India.
authors.forename: Reena
authors.initials: R
authors.lastname: Engineer
authors.affiliation: Department of Medical Oncology, TMH, Mumbai 400012, India.
authors.forename: Anant
authors.initials: A
authors.lastname: Ramaswamy
authors.affiliation: Department of Medical Oncology, TMH, Mumbai 400012, India.
authors.forename: Arvind
authors.initials: A
authors.lastname: Sahu
authors.affiliation: Department of Medical Oncology, TMH, Mumbai 400012, India.
authors.forename: Saurabh
authors.initials: S
authors.lastname: Zanwar
authors.affiliation: Department of Radiology, TMH, Mumbai 400012, India.
authors.forename: Suprita
authors.initials: S
authors.lastname: Arya
authors.affiliation: Department of Radiation Oncology, TMH, Mumbai 400012, India.
authors.forename: Supriya
authors.initials: S
authors.lastname: Chopra
authors.affiliation: Department of Pathology, TMH, Mumbai 400012, India.
authors.forename: Munita
authors.initials: M
authors.lastname: Bal
authors.affiliation: Department of Medical Gastroenterology, TMH, Mumbai 400012, India.
authors.forename: Prachi
authors.initials: P
authors.lastname: Patil
authors.affiliation: Department of Surgical Oncology, TMH, Mumbai 400012, India.
authors.forename: Ashwin
authors.initials: A
authors.lastname: Desouza
authors.affiliation: Department of Surgical Oncology, TMH, Mumbai 400012, India.
authors.forename: Avanish
authors.initials: A
authors.lastname: Saklani
keywords: 5-FU plus irinotecan plus oxaliplatin (FOLFIRINOX); Locally advanced; downstaging; interim chemotherapy (i-CT); rectal adenocarcinoma; unresectable