Neoadjuvant chemoradiotherapy followed by surgery in patients with unresectable locally advanced colon cancer: a prospective observational study

Abstract

BackgroundThe prognosis of locally unresectable colon cancer (CC) is poor. This prospective observational study aimed to further evaluate the feasibility and efficacy of neoadjuvant chemoradiotherapy (NACRT) followed by surgery in these patients.Patients and methodsWe consecutively enrolled patients who were diagnosed with locally unresectable CC from November 2010 to March 2017, and received NACRT followed by surgery. The data of all the patients were collected prospectively. The R0 resection, down-stage and pathologic complete response (pCR) rates were calculated to evaluate the short-term treatment effects. The overall survival (OS) was used to evaluate the long-term outcome. The incidence of NACRT-related acute toxicities and postsurgical complications were used to assess the safety.ResultsA total of 60 patients were eligible for analysis, including 57 (95.0%) patients who attained resectability after NACRT. Among patients managed with surgery, 49 cases (86.0%) achieved R0 resection, and 15 cases (26.3%) achieved pCR. Down T stage was seen in 47 cases (82.5%), and down N stage was seen in 53 cases (93.0%). After a median follow-up time of 26 months, the OS appeared as 76.7%. The most common grade 3/4 NACRT-related toxicity was myelosuppression (incidence, 20.0%). The incidence of grade 3/4 surgery-related complication was 7.0%.ConclusionNACRT might be a safe and effective choice for patients with locally unresectable CC to improve treatment effects, long-term survival and life quality, though further validation is needed.

The expression of brown fat‐associated proteins in colorectal cancer and the relationship of uncoupling protein 1 with prognosis

“…Therefore, UCP1 could also be a useful biopsy‐biomarker since it would provide prognostic information at an early stage prior to tumour resection. This is particularly relevant as neoadjuvant therapy followed by active surveillance is a treatment strategy which is likely to be increasingly used …”

ERCC overexpression associated with a poor response of cT4b colorectal cancer with FOLFOX‑based neoadjuvant concurrent chemoradiation

“…T4b CRC is associated with a poor prognosis due to the direct local extension or infiltration into surrounding structures or organs, thus causing unresectability or a high incidence of nodal and distant metastases ( 12 , 20 , 21 ). As it involves adhesion to the adjacent organs, complete resection of cT4b CRC is difficult, as the organs may be damaged during resection.…”

Neoadjuvant chemoradiotherapy for patients with unresectable radically locally advanced colon cancer: a potential improvement to overall survival and decrease to multivisceral resection

“…Actually, several reports with a small sample size have evaluated NACRT followed by radical surgery for LACC [ 7 ]. We also previously published several studies with small sample sizes [ 8 , 9 ]. Results suggest that patients with LACC may benefit from NACRT.…”