Transcatheter rectal arterial chemoembolization with oxaliplatin and concurrent chemoradiotherapy in patients with locally advanced rectal cancer: A retrospective comparative study

Background: The aim of the study is to assess whether transcatheter rectal arterial chemoembolization (TRACE) with oxaliplatin could increase the pathologic complete response (pCR) rate of locally advanced rectal cancer (LARC) and improve survival outcomes, while minimizing adverse events compared to preoperative chemoradiotherapy (CRT) alone.

Methods: Eligible LARC patients who received TRACE with oxaliplatin plus chemoradiotherapy (the NATRACE-CRT group) or preoperative CRT alone (the NA-CRT group) were retrospectively selected from the database of our institution. Pathological results, treatment-related adverse events and survival in the two groups were compared.

Results: A total of 236 patients were enrolled. The pCR rates were 18.38 % in the NATRACE-CRT group and 14.00 % in the NA-CRT group, with a non-significant difference of 4.38 % (P = 0.473). The median follow-up time was 42 months. The 5-year DFS (75.7 % vs. 73.2 %; P = 0.879) and OS (73.4 % vs. 70.3 %; P = 0.855) rates were comparable between the NATRACE-CRT group and the NA-CRT group. However, the NATRACE-CRT group had significantly fewer patients achieving TRG3 compared to the NA-CRT group (16.18 % vs. 35.00 %; P = 0.001). Furthermore, TRG3 patients in the NATRACE-CRT group exhibited significantly longer OS compared to those in the NA-CRT group (5-year OS: 88.9 % vs 59.5 %; P = 0.016).

Conclusions: TRACE with oxaliplatin demonstrates potential in improving treatment response and prognosis of LARC patients with chemoradiotherapy resistance.