Reply to “The impact of adding mitomycin-C to radiotherapy plus oral tegafur-uracil (CCRT) on advanced-stage rectal cancer?”

Q: How do the authors address concerns about chemotherapy compliance and blood count effects?

They agree poor compliance is not limited to impaired bone marrow function and can apply to other chronically ill patients. They report routine CBC checks and explain that UFUR has relatively low leukopenia incidence, while mitomycin-C is stronger and requires careful attention in patients with compromised marrow function.

Q: Why did the authors not find factors affecting down-staging?

They state down-staging is important for disease-free and overall survival. However, limitations in case number and the retrospective design prevented identifying influencing factors in their dataset.

Q: What relationship did the authors observe between anastomosis leakage and oncologic outcomes?

They agree anastomosis leakage relates to poor oncologic outcome. In their data, the leakage group showed a higher failure rate than the non-leakage group, but the difference did not reach statistical significance, likely due to limited sample size.

Sep 29, 2026

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Letter to the editor responding to questions about a study adding mitomycin-C to radiotherapy plus oral tegafur-uracil (CCRT) for advanced-stage rectal cancer. Authors clarify chemotherapy compliance concerns, noting that patients were screened with baseline CBC and that UFUR has relatively low leukopenia incidence, while mitomycin-C requires careful consideration of impaired bone marrow function. They discuss down-staging as a factor for survival but report no identified determinants due to case-number and retrospective limits. They also examine anastomosis leakage outcomes and statistical non-significance.

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Letter to the Editor

Response to chemotherapy compliance and bone marrow function

Response to down-staging factors and survival

Response to anastomosis leakage and oncologic outcomes

References and publication details

J Chin MedAssoc LETTER TO THE EDITOR Reply to “The impact of adding mitomycin-C to radiotherapy plus oral tegafur-uracil (CCRT) on advanced-stage rectal cancer?” Ling-Wei Wanga, Yu-Shih Liua, Jeng-Kai Jianga,* aDivision of Colon and Rectal Surgery, Department of Surgery, Taipei Veteran General Hospital, Taipei, Taiwan, ROC Dear Editor, Thank you so much your reading and feedback of the paper. Please refer to the following responses for your questions.1 For the first question, we agree that poor compliance of chemotherapy is not only limited to impaired bone marrow function, but also can be applicable to all other chronically-ill patients. Baseline complete blood count (CBC) had been routinely checked in all of our patients before and during concurrent chemoradiotherapy to exclude patients with leucopenia (<4000/μL) before ongoing dosages. The regimen of neoadjuvant chemotherapy in our study is oral UFUR, which has relatively low incidence of side effects including leukopenia.2 However, Mitomycin-C is a stronger agent. So in our experience, patients had impaired bone marrow function should be more carefully in higher dose chemotherapy, including using of Mitomycin-C. For the second question, down-staging rate was an important factor that influence disease-free and overall survival.3 We also had tried to find out the factors that influence down-staging in our data. However, maybe because of the limitation of the case number and retrospective nature of this study, we could not find out the factors in our study.4 For the last question, we agreed that anastomosis leakage has relationship to poor oncological outcome. In our data, there were 24 patients suffered from anastomosis leakage, 1 of them (4 . 1%) had local recurrence, 8 of them (33 . 3%) had distance metastasis, and 1 of them (4 . 1%) had both local recurrence and distance metastasis. The failure rate of the anastomosis leakage group was higher than that of the non-leakage group (41.7% vs 32.0%, p = 0.371) . However, the result did not reach statistical significance, maybe also due to the limitation of case number. Thank you again for your letter. We hope that our responses could be of help to you. REFERENCES 1. Li YT, Chang WH. The impact of adding mitomycin-C to radiotherapy plus oral tegafur-uracil (CCRT) on advanced-stage rectal cancer. J Chin Med Assoc 2023;86:256 . 2. Wang LW, Yang SH, Lin JK, Lin TZ, Chan WK, Chen WS, et al. Preoperative chemoradiotherapy with oral tegafur-uracil and leucovorin for rectal cancer. J Surg Oncol 2005;89:256–63 . 3. Madbouly KM, Hussein AM. Changing operative strategy from abdominoperineal resection to sphincter preservation in T3 low rectal cancer after downstaging by neoadjuvant chemoradiation: a preliminary report. World J Surg 2015;39:1248–56 . 4. Wang LW, Liu YS, Jiang JK. The effect of Mitomycin-C in neoadjuvant concurrent chemoradiotherapy for rectal cancer. J Chin Med Assoc 2022;85:1120–5 . Received November 21, 2022; accepted November 30, 2022. * Address correspondence. Dr. Jeng-Kai Jiang, Department of Surgery, Taipei, Veterans General Hospital, 201, Section 2, Shi-Pai Road, Taipei 112, Taiwan, [ROC. E-mail address: jkjiang@vghtpe.gov.tw](ROC. E-mail address: jkjiang@vghtpe.gov.tw) (J.-K. Jiang). Author contributions: Dr. Ling-Wei Wang and Dr. Yu-Shih Liu contributed equally to this work. Conflicts of interest: The authors declare that they have no conflicts of interest related to the subject matter or materials discussed in this article. Journal of Chinese Medical Association. (2023) 86: 257. Received November 21, 2022; accepted November 30, 2022. doi: 10. 1097/JCMA.0000000000000865. Copyright © 2022, the Chinese Medical Association. This is an open access article under the CC BY-NC-ND license ([http://creativecommons.org/licenses/](http://creativecommons.org/licenses/)[ ](http://creativecommons.org/licenses/)[by-nc-nd/4.0/](by-nc-nd/4.0/)) [www.ejcma.org](www.ejcma.org) 257

FAQs

How do the authors address concerns about chemotherapy compliance and blood count effects?

They agree poor compliance is not limited to impaired bone marrow function and can apply to other chronically ill patients. They report routine CBC checks and explain that UFUR has relatively low leukopenia incidence, while mitomycin-C is stronger and requires careful attention in patients with compromised marrow function.

Why did the authors not find factors affecting down-staging?

They state down-staging is important for disease-free and overall survival. However, limitations in case number and the retrospective design prevented identifying influencing factors in their dataset.

What relationship did the authors observe between anastomosis leakage and oncologic outcomes?

They agree anastomosis leakage relates to poor oncologic outcome. In their data, the leakage group showed a higher failure rate than the non-leakage group, but the difference did not reach statistical significance, likely due to limited sample size.

Sep 29, 2026

Uploaded by วิน