Critical reappraisal of neoadjuvant concurrent chemoradiotherapy for treatment of locally advanced colon cancer

Abstract

Background Locally advanced colon cancer (LACC) is associated with surgical challenges during R0 resection, increased postoperative complications, and unfavorable treatment outcomes. Neoadjuvant concurrent chemoradiotherapy followed by surgical resection is an effective treatment strategy that can increase the complete surgical resection rate and improve the patient survival rate. This study investigated the efficacy and toxicity of concurrent chemoradiotherapy in patients with LACC as well as the prognosis and long-term clinical outcomes of these patients. Materials From January 2012 to July 2020, we retrospectively reviewed the real-world data of 75 patients with LACC who received neoadjuvant concurrent chemoradiotherapy. The chemotherapy regimen consisted of folinic acid, 5-fluorouracil, and oxaliplatin (FOLFOX). The following data were obtained from medical records: patients’ characteristics, pathologic results, toxicity, and long-term oncologic outcome. Results Of the 75 patients, 13 (17.3%) had pathologic complete responses. Hematologic adverse effects were the most common (grade 1 anemia: 80.0% and leukopenia: 82.7%). Conversely, grade 2 or 3 adverse effects were relatively uncommon (<10%). Pathologic N downstaging, ypT0, and pathologic complete responses were significant prognostic factors for patient survival. Multivariate analysis revealed that pathologic N downstaging was an independent predictor of patients’ overall survival (P = 0.019). The estimated 5-year overall and disease-free survival rates were 68.6% and 50.6%, and the medians of overall and disease-free survival periods were 72.3 and 58.7 months, respectively. Moreover, patients with pathologic complete responses had improved overall survival (P = 0.039) and an improved local recurrence control rate (P = 0.042) but an unfavorable distant metastasis control rate (P = 0.666) in the long-term follow-up. Conclusion The long-term oncologic outcome of patients with LACC following concurrent chemoradiotherapy is acceptable, and the adverse effects seem to be tolerable. Pathologic N downstaging was an independent prognostic factor for patients’ overall survival. However, a large prospective, randomized control study is required to confirm the current results.

Comprehensive Review of Biomarkers for the Treatment of Locally Advanced Colon Cancer

“…However, few studies have specifically focused on LACC. Among them, the majority of studies have evaluated the efficacy of MVR and chemoradiotherapy [ 3 , 5 , 14 , 24 , 36 ], with limited relevant biomarker studies scattered among different trials [ 28 , 29 ]. To the best of our knowledge, this is the first comprehensive review of biomarkers for LACC with a focus on different treatment phases ( Table 1 ).…”

“…According to the World Health Organization Global Cancer Observatory report, more than 1.9 million new CRC cases occurred in 2020 worldwide, and among them, 1,148,515 were estimated to be diagnosed as having colon cancer [ 1 ]. Approximately 10–15% of patients with colon cancer are diagnosed late as having locally advanced colon cancer (LACC), which has poor prognosis [ 2 , 3 , 4 , 5 ]. LACC is defined as primary stage T4 colon cancer with direct invasion of surrounding organs or extensive regional lymph node (LN) involvement.…”

The role of neoadjuvant chemotherapy in patients with locally advanced colon cancer: A systematic review and meta-analysis

“…Moreover, safety and efficacy of the following surgery may also be influenced because of the implementation of neoadjuvant therapy ( 28 ). Novel and personalized prognostic markers also need to be developed regarding patients with history of NAC ( 29 , 30 ). An initial phase II experience indicates that a large proportion of patients with NAC might be converted to a low-risk state before surgery, thereby eliminating the need for following adjuvant chemotherapy ( 31 ).…”

The auxiliary effects of low-molecular-weight fucoidan on the quality of life for locally advanced rectal cancer patients receiving neoadjuvant concurrent chemoradiotherapy before surgery: A double-blind, randomized, placebo- controlled study

“…CRC is also a major contributor to cancerassociated morbidity [14]. Rectal cancers account for over one-third of CRC cases and are frequently diagnosed as locally advanced rectal cancer (LARC) [15]. Neoadjuvant concurrent chemoradiotherapy (CCRT) followed by surgical resection is a standard treatment for LARC located in the middle or lower rectum [15].…”