Oncological impact of adjuvant chemotherapy after rectal cancer excision in the era of FOLFIRINOX-based TNT: A pooled post-hoc analysis of GRECCAR4-PRODIGE23.
Eur J CancerSep 11, 2026 (epub)
Quentin Denost, Philippe Rouanet, Eva Teruel et al.
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In 30 seconds
This multicenter randomized controlled trial analyzed the impact of adjuvant chemotherapy (AC) on oncological outcomes in patients with locally advanced rectal cancer (LARC) following total neoadjuvant therapy (TNT) or chemoradiotherapy (CRT). Among 489 patients, AC significantly improved 3-year disease-free survival (DFS) in ypN+ patients after CRT (p < 0.001), but not after TNT. Overall 3-year DFS was 77%.
Key findings
- 3-year DFS was significantly improved in the AC+ group for ypN+ patients after CRT (p < 0.001).
- No significant difference in 3-year DFS for ypN0/cN+ patients regardless of treatment (TNT p = 0.33, CRT p = 0.45).
- AC+ group had significantly better 3-year OS, DMFS, and LRFS for ypN+ after CRT (all p < 0.001).
Why it matters
The findings suggest that adjuvant chemotherapy may be beneficial for ypN+ patients after CRT, but not after TNT, indicating a need for individualized postoperative treatment strategies in rectal cancer management.