Comparison of Neoadjuvant Chemoradiotherapy With versus Without Consolidation FOLFOX in Locally Advanced Rectal Cancer: A Retrospective Cohort Study
Warut Boonnithi, MD¹
Affiliation : ¹ Department of Surgery, Maharat Nakhon Ratchasima Hospital, Nakhon Ratchasima, Thailand
Abstract
Background: Total neoadjuvant therapy (TNT), including consolidation chemotherapy after chemoradiotherapy (CCRT), has emerged as a promising strategy for locally advanced rectal cancer (LARC). However, real-world data from Thailand remain limited.
Objective: To compare pathological and oncologic outcomes between neoadjuvant CCRT alone and CCRT followed by consolidation FOLFOX in patients with LARC.
Materials and Methods: This retrospective cohort study was conducted at Maharat Nakhon Ratchasima Hospital between January 2017 and December 2024. Patients with histologically confirmed locally advanced middle and lower rectal adenocarcinoma (T3-T4 and/or N+) who underwent neoadjuvant treatment followed by curative-intent surgery were included. Patients were divided into two groups: CCRT alone and CCRT followed by consolidation FOLFOX. The primary outcome was pathologic complete response (pCR). Secondary outcomes included 5-year disease-free survival (DFS), overall survival (OS), and local recurrence rate.
Results: A total of 201 patients were included, with 184 in the CCRT group and 17 in the CCRT plus consolidation group. The consolidation group demonstrated a significantly higher pCR rate compared to the CCRT group (52.9% vs. 9.8%, p<0.001). The interval from CCRT to surgery was significantly longer in the consolidation group (131.7±56.9 vs. 76.5±29.1 days, p=0.001). There were no significant differences in postoperative complications between groups. After a median follow-up of 49 (35.9-60.8) months in the CCRT group and 29.8 (23.8-37.8) months in the consolidation group (p=0.003), the 5-year OS rates were 91.7% and 83.4% (p=0.622), and the 5-year DFS rates were 93.7% and 65.9% (p=0.112), respectively. The 5-year local recurrence rate was lower in the consolidation group (0% vs. 14.5%, p=0.191).
Conclusion: Consolidation FOLFOX following neoadjuvant CCRT was associated with a significantly higher pCR rate without increasing perioperative morbidity. Although survival differences were not statistically significant, favorable trends were observed. Further prospective studies are needed to confirm these findings.
Received 17 June 2025 | Revised 15 April 2026 | Accepted 21 May 2026
J Med Assoc Thai 2026;109(7):591-6
Keywords : Rectal cancer; Neoadjuvant therapy; FOLFOX; Pathologic complete response; Total neoadjuvant therapy
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