Given the similar outcomes but lower acute toxicity and improved compliance with induction chemotherapy compared with adjuvant chemotherapy, integrating effective systemic therapy before chemoradiation and surgery is a promising strategy, a new study published online in the journal Annals of Oncology has shown.

For the study, researchers enrolled 108 patients with distal or middle third, T3-T4 and/or N+ rectal adenocarcinoma selected by magnetic resonance imaging (MRI).

Participants were randomly assigned to arm A (preoperative chemoradiation followed by surgery and four cycles of adjuvant capecitabine and oxaliplatin) or arm B (four cycles of capecitabine and oxaliplatin followed by chemoradiation and surgery).

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Results showed that with a median follow-up of 69.5 months, the 5-year disease-free survival was 64% and 62% in arm A and B, respectively (P = 0.85). The 5-year overall survival was 78% in arm A and 75% in arm B (P = 0.64).

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Researchers found that the 5-year cumulative incidence of local relapse was 2% and 5% in arm A and B, respectively (P = 0.61), while the 5-year cumulative incidence of distant metastases was 21% and 23%, respectively.

The findings show that both treatment strategies yield similar outcomes. The authors conclude that the induction chemotherapy given prior to chemoradiation and surgery should be studied further in phase III trials.


  1. Fernandez-Martos C, Garcia-Albeniz X, Pericay C, et al. Chemoradiation, surgery and adjuvant chemotherapy versus induction chemotherapy followed by chemoradiation and surgery: long-term results of the Spanish GCR-3 phase II randomized trial. Ann Oncol. 2015. [Epub ahead of print]. doi: 10.1093/annonc/mdv223.