Many patients with locally advanced rectalcancer can skip radiotherapy to the pelvic area, and instead be treated with chemotherapy alone and then surgery, say researchers reporting results from the PROSPECT trial. ASCO23
Presenting the findings, Schrag began by noting that approximately half of all new rectal cancer diagnoses have locally advanced disease, which in the US represents 48,000 cases per year.
This depressed bone marrow function can"become a problem for people going into chemotherapy into the future," while infertility and early menopause are"a big deal because we're seeing increasing diagnosis of rectal cancer in people before the age of 50 years." They were randomly assigned to receive either a modified chemotherapy regimen or standard chemoradiation . The mean age of the patients was 57 years, and 34.5% were female. The majority were White.The standard chemoradiotherapy consisted of pelvic radiotherapy at 50.4 Gy over 28 fractions alongside sensitizing chemotherapy with either fluorouracil or capecitabine.
FOLFOX first became available in 2002, and randomized controlled trials showed that it was more effective than 5-fluorouracil alone in colon cancer trials. Five-year disease-free survival was 80.8% in the mFOLFOX6 group and 78.6% among patients assigned to chemoradiotherapy, while 5-year overall survival was 89.5% vs 90.2%, at a nonsignificant hazard ratio for death of 1.04.
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