The effect of Mitomycin-C in neoadjuvant concurrent chemoradiotherapy for rectal cancer - Original Article - Abstract

Q: What is the study’s main purpose regarding Mitomycin-C in nCCRT?

To determine the effect of adding Mitomycin-C to neoadjuvant concurrent chemoradiotherapy for rectal cancer and compare it with neoadjuvant therapy using oral tegafur-uracil alone.

Q: How were patients grouped in the study?

Patients receiving nCCRT followed by radical surgery were retrospectively separated into two groups based on whether the regimen included Mitomycin-C.

Q: What benefits and risks were observed after adding Mitomycin-C?

Adding Mitomycin-C increased tumor down-staging and improved overall survival and disease-free survival, but it also increased low-grade toxicities, particularly neutropenia, genitourinary side effects, and dermatological side effects.

Sep 29, 2026

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Neoadjuvant concurrent chemoradiotherapy followed by total mesorectal excision is standard for advanced rectal cancer, yet the optimal chemotherapy regimen remains uncertain. This retrospective study evaluates whether adding Mitomycin-C to neoadjuvant concurrent chemoradiotherapy improves tumor down-staging and survival outcomes compared with oral tegafur-uracil alone. Across 2000–2017 patients, MMC increased down-staging and improved overall and disease-free survival, while low-grade toxicities, especially neutropenia, urinary/genitourinary effects, and dermatologic effects, were more frequent. Prospective trials are warranted.

LanguageEnglish

CategoryResearch & Report

FormatPDF

Pages6

Reading Time15 min

AccessFree to download

Abstract

1. INTRODUCTION

2. METHODS

2.1. Patients

J Chin MedAssoc ORIGINAL ARTICLE The effect of Mitomycin-C in neoadjuvant concurrent chemoradiotherapy for rectal cancer Ling-Wei Wanga,b, Yu-Shih Liub,c,d,e, Jeng-Kai Jiangb,c,* aDivision of Radiation Oncology, Department of Oncology, Taipei Veteran General Hospital, Taipei, Taiwan, ROC; bSchool of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan, ROC; cDivision of Colon and Rectal Surgery, Department of Surgery, Taipei Veteran General Hospital, Taipei, Taiwan, ROC; dDivision of Colon and Rectal Surgery, Department of Surgery, Changhua Christian Hospital, Changhua, Taiwan, ROC; eDepartment of Surgery, Erlin Christian Hospital, Changhua, Taiwan, ROC Abstract Background: Neoadjuvant concurrent chemoradiotherapy (nCCRT) followed by total mesorectal excision has become the standard of care for advanced rectal cancer, but the most effective regimen of chemotherapeutic agents has not yet been determined. The purpose of this study is to determine the effect of Mitomycin-C (MMC) in nCCRT for rectal cancer. Methods: From 2000 to 2017, patients with rectal adenocarcinoma who received nCCRT followed by radical surgery were enrolled in our study. The patients were retrospectively separated into two groups according to nCCRT regimens (with or without MMC) . Other factors related to cancer down-staging after nCCRT, disease-free survival (DFS) and overall survival (OS) were analyzed. Results: One hundred ninety-five patients received radiotherapy (RT) + MMC + oral tegafur-uracil (UFUR), and 191 patients received RT + UFUR without MMC as neoadjuvant CCRT. Adding MMC might increase the down-staging rate (odds ratio [OR]= 1.520, p = 0.058), and down-staging had significant effect to improve OS (OR = 1.726, p = 0.002) and DFS (OR = 2. 185, p < 0.001) . The OS and DFS were improved in patients who received MMC, although this result did not reach a statistically significant difference. There was a higher incidence of low-grade toxicities in the MMC group, especially neutropenia, genitourinary side effects, and dermatological side effects (p < 0 .001) . Conclusion: Adding MMC to the regimen of nCCRT for rectal adenocarcinoma is shown to increase tumor down-staging rate and improve disease-free and OS, although these benefits come at the cost of increased low-grade toxicities. Prospective randomized studies are needed to explore the role of MMC in nCCRT for rectal cancer. Keywords: Mitomycin; Neoadjuvant therapy; Rectal neoplasms; Radiotherapy 1. INTRODUCTION The foundation of curative treatment for rectal cancer is total mesorectal excision (TME) . In early rectal cancer, TME alone has been considered to be sufficient for curative treatment. But in advanced rectal cancer, additions of chemotherapy and radiotherapy (RT) have been shown to improve the rates of diseasefree survival and overall survival.1–3 In addition, neoadjuvant concurrent chemoradiotherapy (nCCRT) performed before surgery has been found to be effective in local tumor control including tumor down-staging, increasing pathological complete response rate, and sphincter preservation.4,5 Because of * 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. (2022) 85: 1120-1125. Received November 8, 2021; accepted July 14, 2022. doi: 10. 1097/JCMA.0000000000000819. 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

FAQs

What is the study’s main purpose regarding Mitomycin-C in nCCRT?

To determine the effect of adding Mitomycin-C to neoadjuvant concurrent chemoradiotherapy for rectal cancer and compare it with neoadjuvant therapy using oral tegafur-uracil alone.

How were patients grouped in the study?

Patients receiving nCCRT followed by radical surgery were retrospectively separated into two groups based on whether the regimen included Mitomycin-C.

What benefits and risks were observed after adding Mitomycin-C?

Adding Mitomycin-C increased tumor down-staging and improved overall survival and disease-free survival, but it also increased low-grade toxicities, particularly neutropenia, genitourinary side effects, and dermatological side effects.

Sep 29, 2026

Upload by Connor