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

Abstract

Background The management of unresectable locally advanced colon cancer (LACC) remains controversial, as resection is not feasible. The goal of this study was to evaluate the treatment outcomes and toxicity of neoadjuvant chemoradiotherapy (NACRT) followed with surgery and adjuvant chemotherapy in patients with unresectable radically LACC. Methods We included patients who were diagnosed at our institution, 2010–2018. The neoadjuvant regimen consisted of radiotherapy and capecitabine/ 5-fluorouracil-based chemotherapy. Results One hundred patients were identified. The median follow-up time was 32 months. The R0 resection rate, adjusted nonmultivisceral resection rate and bladder preservation rate were 83.0, 43.0 and 83.3%, respectively. The pCR and clinical-downstaging rates were 18, and 81.0%%, respectively. The 3-year PFS and OS rates for all patients were 68.6 and 82.1%, respectively. Seventeen patients developed grade 3–4 myelosuppression, which was the most common adverse event observed after NACRT. Tumor perforation occurred in 3 patients during NACRT. The incidence of grade 3–4 surgery-related complications was 7.0%. Postoperative anastomotic leakage was observed in 3 patients. Conclusions NACRT followed by surgery was feasible and safe for selected patients with LACC, and can be used as a conversion treatment to achieve satisfactory downstaging, long-term survival and quality of life, with acceptable toxicities.

The Effectiveness of Glutathione Redox Status as a Possible Tumor Marker in Colorectal Cancer

“…The incidence and mortality rates vary markedly around the world. Although survival in CRC patients has doubled over the past 20 years, partially due to the generalized administration of chemotherapy and a decrease in postsurgical mortality, about 1.93 million new cases were diagnosed and almost one million cancer deaths occurred in 2020 [11,12].…”

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

“…Second, some studies used small sample sizes [ 70 ], which may lead to bias from lack of statistical power. Some biomarkers indicated a potential predictive or prognostic value in the treatment of LACC, but the effect was not statistically significant [ 39 ] and was not reported in the PubMed database.…”

“…A growing body of evidence supports the notion that neoadjuvant chemoradiotherapy followed by surgery is a reasonable treatment for LACC [ 37 , 38 , 39 ]. However, the discovery of predictive biomarkers of neoadjuvant chemoradiotherapy for LACC is still in progress.…”

“…Notably, patients who achieved a pathological complete response exhibited longer survival than did those who did not achieve a pathological complete response after neoadjuvant chemoradiotherapy. However, the difference was not statistically significant; this was possibly caused by the small sample size [ 39 ].…”

“…Our previous study reported that for 34 patients who underwent neoadjuvant chemoradiotherapy and surgery, the pathological complete response and R0 resection rates were 26.4% and 91.2%, respectively [ 36 ]. Although these studies had small sample sizes, all of them reported that neoadjuvant chemoradiotherapy is feasible and safe for patients with LACC ( Figure 1 ) [ 36 , 37 , 38 , 39 ]. In a single-institutional observational study in which neoadjuvant chemoradiotherapy was administered to 100 patients with unresectable LACC, R0 resection was achieved in 83 patients and grade 3–4 myelosuppression was noted only in 17 patients [ 39 ].…”