Skip to main content

Main menu

  • Home
  • Current Issue
  • Archive
  • Info for
    • Authors
    • Advertisers
    • Editorial Board
  • Other Publications
    • Anticancer Research
    • Cancer Genomics & Proteomics
    • Cancer Diagnosis & Prognosis
  • More
    • IIAR
    • Conferences
  • About Us
    • General Policy
    • Contact
  • Other Publications
    • In Vivo
    • Anticancer Research
    • Cancer Genomics & Proteomics

User menu

  • Register
  • Subscribe
  • My alerts
  • Log in
  • My Cart

Search

  • Advanced search
In Vivo
  • Other Publications
    • In Vivo
    • Anticancer Research
    • Cancer Genomics & Proteomics
  • Register
  • Subscribe
  • My alerts
  • Log in
  • My Cart
In Vivo

Advanced Search

  • Home
  • Current Issue
  • Archive
  • Info for
    • Authors
    • Advertisers
    • Editorial Board
  • Other Publications
    • Anticancer Research
    • Cancer Genomics & Proteomics
    • Cancer Diagnosis & Prognosis
  • More
    • IIAR
    • Conferences
  • About Us
    • General Policy
    • Contact
  • Visit iiar on Facebook
  • Follow us on Linkedin
Research ArticleClinical Studies

Tolerability and Adverse Events of Adjuvant Chemotherapy for Rectal Cancer in Patients With Diverting Ileostomy

JUN TAKAHASHI, SHINGO TSUJINAKA, RYO MAEMOTO, YASUYUKI MIYAKURA, KOICHI SUZUKI, RINTARO FUKUDA, RYOTARO SAKIO, ERIKA MACHIDA and TOSHIKI RIKIYAMA
In Vivo November 2020, 34 (6) 3399-3406; DOI: https://doi.org/10.21873/invivo.12178
JUN TAKAHASHI
Department of Surgery, Saitama Medical Center, Jichi Medical University, Saitama, Japan
  • Find this author on Google Scholar
  • Find this author on PubMed
  • Search for this author on this site
SHINGO TSUJINAKA
Department of Surgery, Saitama Medical Center, Jichi Medical University, Saitama, Japan
  • Find this author on Google Scholar
  • Find this author on PubMed
  • Search for this author on this site
  • For correspondence: tsujinakas@omiya.jichi.ac.jp
RYO MAEMOTO
Department of Surgery, Saitama Medical Center, Jichi Medical University, Saitama, Japan
  • Find this author on Google Scholar
  • Find this author on PubMed
  • Search for this author on this site
YASUYUKI MIYAKURA
Department of Surgery, Saitama Medical Center, Jichi Medical University, Saitama, Japan
  • Find this author on Google Scholar
  • Find this author on PubMed
  • Search for this author on this site
KOICHI SUZUKI
Department of Surgery, Saitama Medical Center, Jichi Medical University, Saitama, Japan
  • Find this author on Google Scholar
  • Find this author on PubMed
  • Search for this author on this site
RINTARO FUKUDA
Department of Surgery, Saitama Medical Center, Jichi Medical University, Saitama, Japan
  • Find this author on Google Scholar
  • Find this author on PubMed
  • Search for this author on this site
RYOTARO SAKIO
Department of Surgery, Saitama Medical Center, Jichi Medical University, Saitama, Japan
  • Find this author on Google Scholar
  • Find this author on PubMed
  • Search for this author on this site
ERIKA MACHIDA
Department of Surgery, Saitama Medical Center, Jichi Medical University, Saitama, Japan
  • Find this author on Google Scholar
  • Find this author on PubMed
  • Search for this author on this site
TOSHIKI RIKIYAMA
Department of Surgery, Saitama Medical Center, Jichi Medical University, Saitama, Japan
  • Find this author on Google Scholar
  • Find this author on PubMed
  • Search for this author on this site
  • Article
  • Figures & Data
  • Info & Metrics
  • PDF
Loading

Abstract

Background/Aim: The impact of diverting ileostomy on the feasibility of adjuvant chemotherapy (ACT) remains unclear. We retrospectively investigated the tolerability and adverse events of ACT for rectal cancer in patients with diverting ileostomy. Patients and Methods: Thirty-three patients who received ACT after curative resection with ileostomy construction for rectal cancer were analyzed. We assessed completion rate, the mean relative dose intensities, and the factors affecting the tolerability of ACT. Results: The completion rate of each chemotherapy regimen was 10 out of 16 patients in oral uracil-tegafur plus leucovorin (UFT/LV), 1 out of 3 patients in oral capecitabine (Capecitabine) and 2 out of 14 patients in capecitabine plus oxaliplatin (CAPOX). The mean relative dose intensities were 77% in UFT/LV, 48% in Capecitabine, and 57% of capecitabine and 42% of oxaliplatin in CAPOX. In multivariate analysis, laparoscopic surgery (Odds ratio=11.6, p=0.021) and receiving preoperative chemoradiotherapy (Odds ratio=32.4, p=0.021) were associated with treatment completion. Conclusion: Completion rate of ACT in patients with diverting ileostomy was lower than that of colorectal cancer patients in the previous studies. UFT/LV may be a more tolerable regimen than Capecitabine or CAPOX in colorectal cancer patients with diverting ileostomy.

  • Adjuvant chemotherapy
  • adverse events
  • ileostomy
  • rectal cancer
  • tolerability

Anastomotic leakage is one of the severe complications of the surgical treatment for rectal cancer, causing morbidity and mortality. Diverting ileostomy is constructed in lower rectal surgery with high risk of anastomotic leakage. Previous reports have demonstrated that constructing a diverting stoma reduces clinically relevant anastomotic leakage (1-3).

Several studies have proven that adjuvant chemotherapy (ACT) improves postoperative survival in patients with stage III colorectal cancer (4-6). In case of advanced lower rectal cancer, ACT is indicated in patients with ileostomy. However, there is scarce data regarding the tolerability of ACT for rectal cancer in patients with diverting ileostomy.

This retrospective cohort study aimed to investigate the tolerability and adverse events of ACT for rectal cancer in patients with diverting ileostomy.

Patients and Methods

Patients. Between April 2011 and March 2018, 33 patients with rectal cancer received ACT after curative resection with ileostomy construction in a single center, Saitama Medical center, Jichi Medical University. We retrospectively reviewed the medical charts of these patients.

ACT is indicated in patients with histologically confirmed stage III (any T, N1–3, M0; according to UICC TNM classification) (7) or high–risk stage II (T4, inadequately sampled lymph node, poorly differentiated tumor, lymphovascular invasion) rectal cancer (8). In the present study, patients who received preoperative chemoradiotherapy were also included.

Bioethics Committee for Clinical Research, Saitama Medical Center, Jichi Medical University approved this study (#S19-164).

Regimens. Chemotherapy regimens were oral uracil-tegafur plus leucovorin (UFT/LV), oral capecitabine (Capecitabine) or capecitabine plus oxaliplatin (CAPOX). Treatment regimen was determined by the attending physicians. CAPOX regimen was initially recommended, and other regimens were alternatively chosen in consideration with comorbidities, performance status and preferences of the patients.

UFT/LV regimen comprised oral uracil-tegafur 300 mg/m2 daily plus leucovorin 75 mg daily on days 1-28 of a 5-week cycle for a total of five cycles. Capecitabine regimen comprised oral capecitabine 2,500 mg/m2 daily on days 1-14 of a 3-week cycle for a total of eight cycles. CAPOX regimen comprised oral capecitabine 2,000 mg/m2 daily on days 1-14 plus intravenous oxaliplatin 130 mg/m2 on day 1 of a 3-week cycle for a total of eight cycles.

Dose adjustment was performed in case of drug toxicity. Adverse events were assessed according to the National Cancer Institute Common Terminology Criteria for Adverse Events (NCI CTCAE) version 4.0 (9).

Endpoints. The endpoints of this study were the treatment completion rate, the average relative dose intensities, the reasons for the discontinuation of ACT, and the rate of adverse events of each chemotherapy regimen. We also assessed the clinical factors affecting the discontinuation of ACT. The patient characteristics [age, sex, body mass index (BMI), and American Society of Anesthesiologists Physical Status Classification (ASA-PS)], the preoperative chemoradiotherapy, the surgical approach (open, laparoscopic), the postoperative high output stoma, the pathology stage, and the interval from surgery to ACT were retrieved from medical records. The postoperative high output stoma was defined as an output ≥2,000 ml per day or an output ≥1500 ml for two consecutive days (10, 11).

Statistical analysis. The statistical analyses were performed using EZR (Saitama Medical Center, Jichi Medical University, Saitama, Japan), which is a graphical user interface for the R software program (The R Foundation for Statistical Computing, Vienna, Austria) (12). Fisher's exact test was used for qualitative data and the Student-t test or the Mann-Whitney U-test was used for quantitative data. A multivariate analysis was performed by logistic regression model. Statistical significance was established at p<0.05.

Results

Patient demographics and clinical characteristics. The characteristics of patients are listed in Table I. The median age of the patients was 64 years (range=34-79). There were 23 men and 10 women. Treatment regimens of ACT were UFT/LV in 16 patients, Capecitabine in 3 patients and CAPOX in 14 patients. Eight patients received preoperative chemoradiotherapy. The surgical approach included open surgery in 18 patients and laparoscopic surgery in 15 patients.

Tolerability and adverse events of ACT (all regimens). The overall completion rate of ACT was 13 out of 33. The percentages of actually received dose (90-100%, 70-90%, 0-70% and 0% of the intended dose) in each cycle of each regimens are shown in Figures 1, 2 and 3. The mean relative dose intensity was the highest in UFT/LV regimen (76.6%) and the lowest in oxaliplatin in CAPOX regimen (42.0%). Grade 3 adverse events occurred in 11 out of 33 patients. The reasons for discontinuation of ACT included adverse events in 16, patient's refusal in 3, and cancer recurrence in 1. The details of tolerability and adverse events of each regimen are described as follows.

Tolerability of UFT/LV. Ten out of 16 patients completed the UFT/LV. The mean of relative dose intensity was 76.6% (Table II). Six patients discontinued the treatment without dose reduction (Figure 1). The reasons for non-completion were related to adverse events in 5 patients and patient refusal in one. A total of 10 patients experienced adverse events of any grade, and 3 patients experienced grade 3 adverse events. The adverse events causing treatment discontinuation were anorexia (4/16) and creatinine increase (1/16) (Table III). Grade 3 adverse events are diarrhea (2/16), dehydration (1/16), creatinine increase (1/16), small intestinal obstruction (1/16) (Table IV).

View this table:
  • View inline
  • View popup
  • Download powerpoint
Table I.

Clinical and demographic characteristics of patients (n=33).

Tolerability of Capecitabine. One out of 3 patients completed the Capecitabine. The mean of relative dose intensity was 47.6% (Table II). Two patients required dose reduction and 1 could complete the planned treatment (Figure 2). Two patients did not complete the treatment, due to adverse events and patient refusal. A total of 2 patients experienced adverse events of any grade, and 1 patient experienced grade 3 adverse events. The adverse events causing treatment discontinuation were neutropenia (1/3) (Table III). Grade 3 adverse event was hand foot syndrome (1/3) (Table IV).

Tolerability of CAPOX. Two out of 14 patients completed the Capecitabine. The mean relative dose intensity of capecitabine and oxaliplatin were 57.1% and 42.0%, respectively (Table II). Because of the adverse events, 4 patients changed from CAPOX regimen to oral capecitabine alone. The treatment changes were performed from the second cycle in 2 patients, from the fourth cycle in 1 patient, and from the seventh cycle in 1 patient. After changing treatment, 2 patients received a total of seven cycles and 2 patients could complete eight cycles. The reasons for non-completion were related to adverse events in 10 patients, patient refusal in 1, and recurrence of rectal cancer in 1 patient. All patients (n=14) experienced adverse events of any grade, and 3 patients experienced grade 3 adverse events. The adverse events causing treatment discontinuation were stomatitis (3/14), diarrhea (2/14), anorexia (1/14), vomiting (1/14), peripheral neuropathy (1/14), neutropenia (1/14), and allergy (1/14) (Table III). Grade 3 adverse events were anorexia (1/14), vomiting (1/14), diarrhea (1/14), dehydration (1/14), and thrombocytopenia (1/14) (Table IV).

Figure 1.
  • Download figure
  • Open in new tab
  • Download powerpoint
Figure 1.

Percentage of received dose of UFT in each cycle of uracil-tegafur plus leucovorin (UFT/LV) regimen.

Figure 2.
  • Download figure
  • Open in new tab
  • Download powerpoint
Figure 2.

Percentages of received dose of Capecitabine in each cycle of Capecitabine regimen.

Clinical factors affecting the tolerability of ACT. The clinical characteristics of the treatment completion and non-completion groups are shown in Table V. One patient who discontinued ACT because of recurrence was excluded and a total of 32 patients were analyzed. There were 15 patients in the completion group (including the 2 patients who completed the treatment after changing from CAPOX to Capecitabine) and 17 patients in the non-completion group. Univariate analysis revealed that laparoscopic surgery (p=0.031) and preoperative chemoradiotherapy (p=0.033) were significantly more frequent in the completion group than in the non-completion group. The incidence of postoperative high output stoma was higher in the non-completion group (p=0.041). There were no significant differences in age, gender, regimen, BMI, ASA-PS, pathology stage and interval from operation to start of ACT. Laparoscopic surgery [odds ratio (OR)=11.6; 95% confidence interval (CI)=1.44-92.8; p=0.021 and preoperative chemoradiotherapy (OR=32.4; 95% CI=1.70-619; p=0.021)] were independently associated with the completion of ACT in the multivariate analysis. There was no statistically significant relationship between the incidence of the high output stoma and the preoperative chemoradiotherapy or the surgical approach.

Figure 3.
  • Download figure
  • Open in new tab
  • Download powerpoint
Figure 3.

(A) Percentages of received dose of Capecitabine in each cycle of capecitabine plus oxaliplatin (CAPOX) regimen. (B) Percentages of received dose of Oxaliplatin in each cycle of capecitabine plus oxaliplatin (CAPOX) regimen.

Discussion

In this study, we evaluated the tolerability of ACT for rectal cancer in patients with diverting ileostomy. The completion rate of ACT was relatively lower than that reported in the literature for colorectal cancer. In our study, the completion rates of UFT/LV, Capecitabine and CAPOX were 10 out of 16 patients, 1 out of 3 patients and 2 out of 14 patients respectively, although previous studies in Japanese patients with colorectal cancer have reported 73-77%, 66% and 73.7%, respectively (5, 13-15). In addition, previous studies have shown that low completion rate and low relative dose intensity of ACT had negative impact on overall survival rate (16, 17).

View this table:
  • View inline
  • View popup
  • Download powerpoint
Table II.

Completion rate and relative dose intensity (RDI) of each regimen.

To discuss about the association between lower completion rate of ACT and ileostomy, it is necessary to consider the increased incidence of adverse events in CAPOX regimen (Tables III and IV) and the decreased sustainability in Capecitabine or CAPOX regimens (Figures 2 and 3) when indicating ACT to patients with diverting ileostomy. The completion rate of CAPOX was only 2 out of 14 patients, and 2 patients completed the treatment after switching to Capecitabine alone. A previous study with a larger number of Japanese patients regarding safety and efficacy of CAPOX as adjuvant chemotherapy (MCSCO-1024) reported a completion rate of 73.7%, which included switching to capecitabine alone (13). In that study, reasons for discontinuation of ACT were patient refusal of 16.8%, disease recurrence of 5.8%, and adverse event of 3.7%. On the other hand, most of the reasons for the discontinuation in present study were the adverse events. Similar to the previous study by Danno et al. (13), the most frequent adverse event in our study was peripheral neuropathy. However, the adverse events causing the discontinuation of ACT were gastroenterological events such as stomatitis, diarrhea, anorexia, and vomiting. In our study, discontinuation of ACT was mostly observed within the fourth cycle. These results suggest that adequate monitoring of the gastroenterological symptoms and changing the dose early may contribute to a higher treatment completion rate.

View this table:
  • View inline
  • View popup
  • Download powerpoint
Table III.

Reasons for discontinuation of each regimen.

In the present study, the UFT/LV regimen showed a trend for higher tolerability than Capecitabine or CAPOX. Although the difference in completion rate of each ACT regimen did not reach statistical significance in present study, this result must be carefully interpreted considering the small number of studied patients and the decision bias in the selection of ACT. The completion rate for UFT/LV (10/16) was lower than in the ACTS-CC trial (73.4%), but the mean relative dose intensity of UFT/LV in our study (76.6%) was similar to the one reported in the ACTS-CC trial (76.5%) (15). The overall incidences of any grade and grade 3 adverse events were 63.5% and 18.8% respectively, in this study, while the ACTS-CC trial reported 73.7% and 14.4% (15). These results suggest that the feasibility of ACT with UFT/LV in patients with ileostomy is acceptable.

The analysis of clinical factors affecting the tolerability of ACT showed that patients with laparoscopic surgery and preoperative chemoradiotherapy were significantly more frequent in the completion than in the non-completion group. Increased tolerability of ACT after laparoscopic surgery might be associated with better postoperative recovery after minimal invasive surgery. Previous studies have demonstrated that laparoscopic colectomy improved short-term surgical outcome (18, 19). Kim et al. have shown that laparoscopic colectomy contributed to greater compliance and earlier initiation of ACT (20).

There is scarce data regarding the relationship between preoperative chemoradiotherapy and tolerability of ACT. In present study, the patients receiving preoperative chemoradiotherapy had already been exposed to chemotherapy before ACT. Therefore, this experience may contribute to improved management for adverse events and dose reduction compared to those without preoperative chemoradiotherapy. Postoperative high output stoma was associated with non-completion, although stoma output and dehydration were well controlled by medication before ACT started. Three patients who suffered from chemotherapy-induced diarrhea also experienced postoperative high output stoma before ACT. The incidence of postoperative high output stoma may be indicator of high risk for adverse events.

View this table:
  • View inline
  • View popup
  • Download powerpoint
Table IV.

Adverse events for each regimen.

View this table:
  • View inline
  • View popup
  • Download powerpoint
Table V.

Analysis of clinical factors completion group versus non-completion group.

Ileostomy occasionally causes dehydration and acute kidney disease due to the high output stoma and some patients need readmission because of stoma associated complications (21, 22). Robertson et al. (23) reported that the ileostomy was associated with severe chemotherapy-induced diarrhea and that it required chemotherapy regimen changes. In our study, 4 out of 33 patients experienced chemotherapy-induced diarrhea, and in 3 of the 4 it was of grade 3. One patient experienced grade 3 acute kidney disease and needed rehospitalization. The incidence of the chemotherapy-induced diarrhea was not higher than in previous studies, whereas the percentage of grade 3 was higher (13, 15, 23). These results indicated that once diarrhea is induced by ACT, presence of ileostomy might be a prognostic factor for severe adverse events.

Certain reports have addressed the timing of stoma closure in the context of ACT, but the appropriate timing of ileostomy closure is still controversial. Hajibandeh et al. (24), in a meta-analysis regarding ileostomy closure during versus after ACT, showed that there was no significant difference in surgical complication and length of postoperative hospital stay after stoma closure. Zhen et al. (25) demonstrated that patients who underwent stoma closure 6 months after surgery received more cycles of ACT than patients who underwent stoma closure 3 months after surgery. Brown et al. (26) reported that overall survival was similar in patients who underwent ileostomy closure before and after ACT for rectal cancer. There is no report about the relationship between the completion rate of ACT and the diverting ileostomy. Currently, a randomized clinical trial (27) studying the completion of ACT early versus late stoma closure (CoCStom trial) is ongoing.

Our study has potential limitations. It is a retrospective study, with a small sample size. Another limitation is that dose reduction criteria and discontinuation criteria were not strictly defined and were determined by the attending physicians. In this study, we focused specifically on tolerability and adverse event of ACT in patients with ileostomy. We will continue to follow up our patients, and investigate relationship between lower completion rate of ACT, interval from resection of cancer to stoma closure and long-term survival in our future research.

In conclusion, the completion rate of ACT in patients with diverting ileostomy was lower than that of colorectal cancer patients in the previous studies. UFT/LV was reasonably tolerated, while Capecitabine or CAPOX were difficult to continue due to adverse events. Dose reduction or modification of regimens may be considered for sustainable ACT. Larger randomized control studies are warranted to evaluate the tolerability of ACT regimens in patients with diverting ileostomy, to identify the optimal regimen.

Acknowledgements

The Authors would like to thank Editage (www.editage.com) for English language editing.

Footnotes

  • Authors' Contributions

    JT and ST proposed study conception and design. RM, RF, RS and EM performed data collection and acquisition. JT and ST interpreted the data. JT drafted the manuscript. ST, RM, RF, RS and EM edited the manuscript. YM, KS and TR had a role in critical revision of the manuscript. All Authors have read and approved the final version of the manuscript.

  • This article is freely accessible online.

  • Conflicts of Interest

    The Authors declare no conflicts of interest for this article.

  • Received June 8, 2020.
  • Revision received July 25, 2020.
  • Accepted July 31, 2020.
  • Copyright© 2020, International Institute of Anticancer Research (Dr. George J. Delinasios), All rights reserved

References

  1. ↵
    1. Matthiessen P,
    2. Hallbook O,
    3. Rutegard J,
    4. Simert G,
    5. Sjodahl R
    : Defunctioning stoma reduces symptomatic anastomotic leakage after low anterior resection of the rectum for cancer: A randomized multicenter trial. Ann Surg 246(2): 207-214, 2007. PMID: 1766798. DOI: 10.1097/SLA.0b013e3180603024
    OpenUrlCrossRefPubMed
    1. Qu H,
    2. Liu Y,
    3. Bi DS
    : Clinical risk factors for anastomotic leakage after laparoscopic anterior resection for rectal cancer: A systematic review and meta-analysis. Surg Endosc 29(12): 3608-3617, 2015. PMID: 25743996. DOI: 10.1007/s00464-015-4117-x
    OpenUrl
  2. ↵
    1. Tan WS,
    2. Tang CL,
    3. Shi L,
    4. Eu KW
    : Meta-analysis of defunctioning stomas in low anterior resection for rectal cancer. Br J Surg 96(5): 462-472, 2009. PMID: 19358171. DOI: 10.1002/bjs.6594
    OpenUrlCrossRefPubMed
  3. ↵
    1. Andre T,
    2. Boni C,
    3. Navarro M,
    4. Tabernero J,
    5. Hickish T,
    6. Topham C,
    7. Bonetti A,
    8. Clingan P,
    9. Bridgewater J,
    10. Rivera F,
    11. de Gramont A
    : Improved overall survival with oxaliplatin, fluorouracil, and leucovorin as adjuvant treatment in stage II or III colon cancer in the mosaic trial. J Clin Oncol 27(19): 3109-3116, 2009. PMID: 19451431. DOI: 10.1200/jco.2008.20.6771
    OpenUrlAbstract/FREE Full Text
  4. ↵
    1. Shimada Y,
    2. Hamaguchi T,
    3. Mizusawa J,
    4. Saito N,
    5. Kanemitsu Y,
    6. Takiguchi N,
    7. Ohue M,
    8. Kato T,
    9. Takii Y,
    10. Sato T,
    11. Tomita N,
    12. Yamaguchi S,
    13. Akaike M,
    14. Mishima H,
    15. Kubo Y,
    16. Nakamura K,
    17. Fukuda H,
    18. Moriya Y
    : Randomised phase III trial of adjuvant chemotherapy with oral uracil and tegafur plus leucovorin versus intravenous fluorouracil and levofolinate in patients with stage III colorectal cancer who have undergone japanese D2/D3 lymph node dissection: Final results of JCOG0205. Eur J Cancer 50(13): 2231-2240, 2014. PMID: 24958736. DOI: 10.1016/j.ejca.2014.05.025
    OpenUrlCrossRefPubMed
  5. ↵
    1. Twelves C,
    2. Wong A,
    3. Nowacki MP,
    4. Abt M,
    5. Burris H 3rd.,
    6. Carrato A,
    7. Cassidy J,
    8. Cervantes A,
    9. Fagerberg J,
    10. Georgoulias V,
    11. Husseini F,
    12. Jodrell D,
    13. Koralewski P,
    14. Kroning H,
    15. Maroun J,
    16. Marschner N,
    17. McKendrick J,
    18. Pawlicki M,
    19. Rosso R,
    20. Schuller J,
    21. Seitz JF,
    22. Stabuc B,
    23. Tujakowski J,
    24. Van Hazel G,
    25. Zaluski J,
    26. Scheithauer W
    : Capecitabine as adjuvant treatment for stage III colon cancer. N Engl J Med 352(26): 2696-2704, 2005. PMID: 15987918. DOI: 10.1056/NEJMoa043116
    OpenUrlCrossRefPubMed
  6. ↵
    1. Brierley JD,
    2. Gospodarowicz MK,
    3. Wittekind C
    (eds): TNM Classification of Malignant Tumours, 8th Edition. Wiley-Blackwell, pp 73-77, 2016.
  7. ↵
    1. Simillis C,
    2. Singh H,
    3. Afxentiou T,
    4. Mills S,
    5. Warren OJ,
    6. Smith JJ,
    7. Riddle P,
    8. Adamina M,
    9. Cunningham D,
    10. Tekkis PP
    : Postoperative chemotherapy improves survival in patients with resected high-risk stage II colorectal cancer: Results of a systematic review and meta-analysis. Colorectal Dis, 2020. PMID: 31999888. DOI: 10.1111/codi.14994
  8. ↵
    National Cancer Institute Common Terminology Criteria for Adverse Events (CTCAE)v4.0 Available at: http://ctep.cancer.gov/protocolDevelopment/electronic_applications/ctc.htm#ctc_40 (Last accessed on July 24th, 2020)
  9. ↵
    1. Arenas Villafranca JJ,
    2. Lopez-Rodriguez C,
    3. Abiles J,
    4. Rivera R,
    5. Gandara Adan N,
    6. Utrilla Navarro P
    : Protocol for the detection and nutritional management of high-output stomas. Nutr J 14: 45, 2015. PMID: 25956387. DOI: 10.1186/s12937-015-0034-z
    OpenUrl
  10. ↵
    1. Baker ML,
    2. Williams RN,
    3. Nightingale JM
    : Causes and management of a high-output stoma. Colorectal Dis 13(2): 191-197, 2011. PMID: 19888956. DOI: 10.1111/j.1463-1318.2009.02107.x
    OpenUrlCrossRefPubMed
  11. ↵
    1. Kanda Y
    : Investigation of the freely available easy-to-use software ‘ezr’ for medical statistics. Bone Marrow Transplant 48(3): 452-458, 2013. PMID: 23208313. DOI: 10.1038/bmt. 2012.244
    OpenUrlCrossRefPubMed
  12. ↵
    1. Danno K,
    2. Hata T,
    3. Tamai K,
    4. Fujie Y,
    5. Ide Y,
    6. Kim HM,
    7. Ohnishi T,
    8. Morita S,
    9. Yoshioka S,
    10. Kudo T,
    11. Nishimura J,
    12. Matsuda C,
    13. Akamatsu H,
    14. Mizushima T,
    15. Nezu R,
    16. Doki Y,
    17. Mori M
    : Interim analysis of a phase II trial evaluating the safety and efficacy of capecitabine plus oxaliplatin (xelox) as adjuvant therapy in japanese patients with operated stage III colon cancer. Cancer Chemother Pharmacol 80(4): 777-785, 2017. PMID: 28825216. DOI: 10.1007/s00280-017-3419-1
    OpenUrl
    1. Emi Y,
    2. Kakeji Y,
    3. Oki E,
    4. Saeki H,
    5. Ando K,
    6. Kitazono M,
    7. Sakaguchi Y,
    8. Morita M,
    9. Samura H,
    10. Ogata Y,
    11. Akagi Y,
    12. Natsugoe S,
    13. Shirouzu K,
    14. Tokunaga S,
    15. Sirzen F,
    16. Maehara Y
    : Initial report of kscc0803: Feasibility study of capecitabine as adjuvant chemotherapy for stage III colon cancer in japanese patients. Int J Clin Oncol 18(2): 254-259, 2013. PMID: 22240888. DOI: 10.1007/s10147-011-0371-7
    OpenUrl
  13. ↵
    1. Mochizuki I,
    2. Takiuchi H,
    3. Ikejiri K,
    4. Nakamoto Y,
    5. Kinugasa Y,
    6. Takagane A,
    7. Endo T,
    8. Shinozaki H,
    9. Takii Y,
    10. Takahashi Y,
    11. Mochizuki H,
    12. Kotake K,
    13. Kameoka S,
    14. Takahashi K,
    15. Watanabe T,
    16. Watanabe M,
    17. Boku N,
    18. Tomita N,
    19. Matsubara Y,
    20. Sugihara K
    : Safety of uft/lv and s-1 as adjuvant therapy for stage III colon cancer in phase III trial: Acts-cc trial. Br J Cancer 106(7): 1268-1273, 2012. PMID: 22415232. DOI: 10.1038/bjc.2012.86
    OpenUrlCrossRefPubMed
  14. ↵
    1. Aspinall SL,
    2. Good CB,
    3. Zhao X,
    4. Cunningham FE,
    5. Heron BB,
    6. Geraci M,
    7. Passero V,
    8. Stone RA,
    9. Smith KJ,
    10. Rogers R,
    11. Shields J,
    12. Sartore M,
    13. Boyle DP,
    14. Giberti S,
    15. Szymanski J,
    16. Smith D,
    17. Ha A,
    18. Sessions J,
    19. Depcinski S,
    20. Fishco S,
    21. Molina I,
    22. Lepir T,
    23. Jean C,
    24. Cruz-Diaz L,
    25. Motta J,
    26. Calderon-Vargas R,
    27. Maland J,
    28. Keefe S,
    29. Tague M,
    30. Leone A,
    31. Glovack B,
    32. Kaplan B,
    33. Cosgriff S,
    34. Kaster L,
    35. Tonnu-Mihara I,
    36. Nguyen K,
    37. Carmichael J,
    38. Clifford L,
    39. Lu K,
    40. Chatta G
    : Adjuvant chemotherapy for stage III colon cancer: Relative dose intensity and survival among veterans. BMC Cancer 15: 62, 2015. PMID: 25884851. DOI: 10.1186/s12885-015-1038-y
    OpenUrl
  15. ↵
    1. Morris M,
    2. Platell C,
    3. Fritschi L,
    4. Iacopetta B
    : Failure to complete adjuvant chemotherapy is associated with adverse survival in stage III colon cancer patients. Br J Cancer 96(5): 701-707, 2007. PMID: 17299387. DOI: 10.1038/sj.bjc.6603627
    OpenUrlCrossRefPubMed
  16. ↵
    1. Schwenk W,
    2. Haase O,
    3. Neudecker J,
    4. Müller JM
    : Short term benefits for laparoscopic colorectal resection. Cochrane Database Syst Rev 3: Cd003145, 2005. PMID: 16034888. DOI: 10.1002/14651858.CD003145.pub2
  17. ↵
    1. Yamamoto S,
    2. Inomata M,
    3. Katayama H,
    4. Mizusawa J,
    5. Etoh T,
    6. Konishi F,
    7. Sugihara K,
    8. Watanabe M,
    9. Moriya Y,
    10. Kitano S
    : Short-term surgical outcomes from a randomized controlled trial to evaluate laparoscopic and open D3 dissection for stage II/III colon cancer: Japan clinical oncology group study jcog 0404. Ann Surg 260(1): 23-30, 2014. PMID: 24509190. DOI: 10.1097/sla.0000000000000499
    OpenUrlCrossRefPubMed
  18. ↵
    1. Kim RH,
    2. Kavanaugh MM,
    3. Caldito GC
    : Laparoscopic colectomy for cancer: Improved compliance with guidelines for chemotherapy and survival. Surgery 161(6): 1633-1641, 2017. PMID: 28027818. DOI: 10.1016/j.surg.2016.11.024
    OpenUrl
  19. ↵
    1. Messaris E,
    2. Sehgal R,
    3. Deiling S,
    4. Koltun WA,
    5. Stewart D,
    6. McKenna K,
    7. Poritz LS
    : Dehydration is the most common indication for readmission after diverting ileostomy creation. Dis Colon Rectum 55(2): 175-180, 2012. DOI: 10.1097/DCR.0b013e31823d0ec5
    OpenUrlCrossRefPubMed
  20. ↵
    1. Yaegashi M,
    2. Otsuka K,
    3. Kimura T,
    4. Matsuo T,
    5. Fujii H,
    6. Sato K,
    7. Takashimizu K,
    8. Hatanaka T,
    9. Yoshida T,
    10. Tono C,
    11. Sasaki A
    : Early renal dysfunction after temporary ileostomy construction. Surg Today 50(7): 703-710, 2019. PMID: 31865459. DOI: 10.1007/s00595-019-01938-y
    OpenUrl
  21. ↵
    1. Robertson JP,
    2. Wells CI,
    3. Vather R,
    4. Bissett IP
    : Effect of diversion ileostomy on the occurrence and consequences of chemotherapy-induced diarrhea. Dis Colon Rectum 59(3): 194-200, 2016. PMID: 2685593. DOI: 10.1097/dcr.0000000000000531
    OpenUrl
  22. ↵
    1. Hajibandeh S,
    2. Hajibandeh S,
    3. Sarma DR,
    4. East J,
    5. Zaman S,
    6. Mankotia R,
    7. Thompson CV,
    8. Torrance AW,
    9. Peravali R
    : Meta-analysis of temporary loop ileostomy closure during or after adjuvant chemotherapy following rectal cancer resection: The dilemma remains. Int J Colorectal Dis 34(7): 1151-1159, 2019. PMID: 31129697. DOI: 10.1007/s00384-019-03321-2
    OpenUrl
  23. ↵
    1. Zhen L,
    2. Wang Y,
    3. Zhang Z,
    4. Wu T,
    5. Liu R,
    6. Li T,
    7. Zhao L,
    8. Deng H,
    9. Qi X,
    10. Li G
    : Effectiveness between early and late temporary ileostomy closure in patients with rectal cancer: A prospective study. Curr Probl Cancer 41(3): 231-240, 2017. PMID: 28434582. DOI: 10.1016/j.currproblcancer.2017.02.007
    OpenUrl
  24. ↵
    1. Brown SR,
    2. Khan B,
    3. Green HJ,
    4. Beck DE
    : Overall survival associated with ileostomy closure in patients with rectal cancer before and after adjuvant therapy. Ochsner J 17(4): 328-330, 2017. PMID: 29230116.
    OpenUrlAbstract/FREE Full Text
  25. ↵
    1. Sandra-Petrescu F,
    2. Herrle F,
    3. Hinke A,
    4. Rossion I,
    5. Suelberg H,
    6. Post S,
    7. Hofheinz RD,
    8. Kienle P
    : Cocstom trial: Study protocol for a randomised trial comparing completeness of adjuvant chemotherapy after early versus late diverting stoma closure in low anterior resection for rectal cancer. BMC Cancer 15: 923, 2015. PMID: 26589718. DOI: 10.1186/s12885-015-1838-0
    OpenUrl
PreviousNext
Back to top

In this issue

In Vivo: 34 (6)
In Vivo
Vol. 34, Issue 6
November-December 2020
  • Table of Contents
  • Table of Contents (PDF)
  • Index by author
  • Back Matter (PDF)
  • Ed Board (PDF)
  • Front Matter (PDF)
Print
Download PDF
Article Alerts
Sign In to Email Alerts with your Email Address
Email Article

Thank you for your interest in spreading the word on In Vivo.

NOTE: We only request your email address so that the person you are recommending the page to knows that you wanted them to see it, and that it is not junk mail. We do not capture any email address.

Enter multiple addresses on separate lines or separate them with commas.
Tolerability and Adverse Events of Adjuvant Chemotherapy for Rectal Cancer in Patients With Diverting Ileostomy
(Your Name) has sent you a message from In Vivo
(Your Name) thought you would like to see the In Vivo web site.
CAPTCHA
This question is for testing whether or not you are a human visitor and to prevent automated spam submissions.
4 + 0 =
Solve this simple math problem and enter the result. E.g. for 1+3, enter 4.
Citation Tools
Tolerability and Adverse Events of Adjuvant Chemotherapy for Rectal Cancer in Patients With Diverting Ileostomy
JUN TAKAHASHI, SHINGO TSUJINAKA, RYO MAEMOTO, YASUYUKI MIYAKURA, KOICHI SUZUKI, RINTARO FUKUDA, RYOTARO SAKIO, ERIKA MACHIDA, TOSHIKI RIKIYAMA
In Vivo Nov 2020, 34 (6) 3399-3406; DOI: 10.21873/invivo.12178

Citation Manager Formats

  • BibTeX
  • Bookends
  • EasyBib
  • EndNote (tagged)
  • EndNote 8 (xml)
  • Medlars
  • Mendeley
  • Papers
  • RefWorks Tagged
  • Ref Manager
  • RIS
  • Zotero
Reprints and Permissions
Share
Tolerability and Adverse Events of Adjuvant Chemotherapy for Rectal Cancer in Patients With Diverting Ileostomy
JUN TAKAHASHI, SHINGO TSUJINAKA, RYO MAEMOTO, YASUYUKI MIYAKURA, KOICHI SUZUKI, RINTARO FUKUDA, RYOTARO SAKIO, ERIKA MACHIDA, TOSHIKI RIKIYAMA
In Vivo Nov 2020, 34 (6) 3399-3406; DOI: 10.21873/invivo.12178
Reddit logo Twitter logo Facebook logo Mendeley logo
  • Tweet Widget
  • Facebook Like
  • Google Plus One

Jump to section

  • Article
    • Abstract
    • Patients and Methods
    • Results
    • Discussion
    • Acknowledgements
    • Footnotes
    • References
  • Figures & Data
  • Info & Metrics
  • PDF

Related Articles

  • No related articles found.
  • PubMed
  • Google Scholar

Cited By...

  • No citing articles found.
  • Google Scholar

More in this TOC Section

  • Preferences Regarding Breast Surgery Omission Among Patients With Breast Cancer Who Receive Neoadjuvant Chemotherapy
  • Forensic Medical Examination After Sexual Violence: Implications Based on Victims’ Perceptions
  • Albumin–derived Neutrophil-to-Lymphocyte Ratio Score as a Marker of Nivolumab Treatment Sensitivity in Gastric Cancer: A Multicenter Study
Show more Clinical Studies

Similar Articles

Keywords

  • adjuvant chemotherapy
  • adverse events
  • ileostomy
  • rectal cancer
  • tolerability
In Vivo

© 2023 In Vivo

Powered by HighWire