To the Editors,
We read with great interest a recent study by Geva et al. (2014) regarding the role for adjuvant chemotherapy in pathological complete response (pCR) rectal cancer tumors following neoadjuvant chemoradiotherapy. We agreed that after neoadjuvant concurrent chemoradiotherapy, “The question whether to add adjuvant chemotherapy in patients who had reached pCR is still unanswered” (Geva et al. 2014). As reported in this study and some other western studies regarding the questionable role of adjuvant chemotherapy in pathological complete response rectal cancer tumors following neoadjuvant therapy (Geva et al. 2014; Capirci et al. 2008; Nelson and Benson 2013), we would like to provide a supplementary evidence from the East as in our previous experiences (Lin et al. 2012; Hsia et al. 2013). With the help of a nation-wide population-based dataset “Collaboration Center of Health Information Application” which included cancer registry and death registry after approved by Research Ethics Committee (CMUH103-REC-005), we identified 891 newly diagnosed (in 2007–2010) American Joint Committee on Cancer clinical stage II–III rectal adenocarcinoma cancer patients who received neoadjuvant concurrent systemic therapy and conventional fractionated radiotherapy. Among those 852 patients received radical R0 resection, 74 reached pCR. Twenty-five of them receiving adjuvant systemic therapy (group A), whereas forty-nine (group B) did not. After median follow-up 12 months (range 6–49), the overall survival (OS) and disease-free survival (DFS) were similar between these two groups (p value 0.47 for OS and 0.5 for DFS) (Fig. 1a, b). After adjusted for potential covariables (including age, gender, clinical stage, type of operation and radiation dose) according to the literatures and our experience (Geva et al. 2014; Capirci et al. 2008; Ke et al. 2014), there were also no statistical difference between these two groups in Cox proportional hazard model. In the era of personalized medicine (Chien and Shih 2013), we believe these data would be of value in considering individualized decision regarding adjuvant chemotherapy in patients who had reached pCR, no matter in the East or in the West.
Fig. 1.
Kaplan–Meier survival curve (in days). a Overall survival. b Disease-free survival
Acknowledgments
The data analyzed in this study were provided by the Collaboration Centre for Health Information Application (CCHIA), Department of Health, Executive Yuan, Taiwan. We thanked the Health and welfare surcharge of tobacco products, China Medical University Hospital Cancer Research Center of Excellence (MOHW103-TD-B-111-03, Taiwan), for their financial support. The authors—not the CCHIA or the funding body—had full control of the design of the study, methods used, outcome parameters and results, analysis of data and production of the written report.
Conflict of interest
The authors declared no conflict of interest.
Footnotes
William Tzu-Liang Chen, Tao-Wei Ke and Chia-Chin Li have equally contributed to this work.
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