Neoadjuvant therapy in locally advanced colon cancer: a meta-analysis and systematic review

Cheong, Chin Kai; Nistala, Kameswara Rishi Yeshayahu; Ng, Cheng Han; Syn, Nicholas; Chang, Heidi; Sundar, Raghav; Yang, Soon Yu; Chong, Choon Seng

doi:10.21037/jgo-20-220

Cited by 62 publications

(51 citation statements)

References 47 publications

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“…For non-hematologic AEs, the incidence of severe AEs was <10%. This result was consistent with our previous studies [ 6 , 11 , 19 , 48 ], and we suggested that neoadjuvant CCRT is a safe and tolerable treatment for patients with LACC.…”

Section: Discussionsupporting

confidence: 93%

“…Obviously, an accurate CT scan image is essential in our treatment program. Many articles have described that CT is a reliable examination to assess the colon cancer stage and devise the subsequent surgical plan [ 7 , 11 , 12 , 16 , 19 ].…”

Section: Discussionmentioning

confidence: 99%

“…In a systemic review in 2020, Cheong et al . found that 12.5%–22% of LACC patients who underwent neoadjuvant chemotherapy developed granulocytopenia [ 19 ], and Zhou et al . reported that 4.3% and 21.7% of LACC patients who underwent neoadjuvant chemotherapy developed moderate to severe anemia and leukopenia, respectively [ 48 ].…”

Section: Discussionmentioning

confidence: 99%

“…Another possible advantage of neoadjuvant CCRT is the eradication of occult systemic micro-metastasis, which might decrease cancer DM [ 8 , 12 , 19 ]. With tumor regression and shrinkage, surgical resection can be less challenging, resulting in fewer postoperative complications [ 7 , 8 , 18 , 19 ]. Moreover, patients are less likely to delay adjuvant therapy due to postoperative complication-related infection or malnutrition [ 12 ].…”

Section: Introductionmentioning

confidence: 99%

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

Chen

Tsai

et al. 2021

PLoS ONE

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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.

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Section: Discussionsupporting

confidence: 93%

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

See 2 more Smart Citations

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

Chen

Tsai

et al. 2021

PLoS ONE

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“…Another possible benefit is the option of neoadjuvant chemotherapy, which has recently been shown to improve oncological outcomes in locally advanced colon cancer [25, 26]. Neoadjuvant chemotherapy can result in downstaging and tumour regression in patients with obstructing or high risk colon cancer [27–30]. In the present study, 24% of the patients with right‐sided colon cancer and 29% of the patients with left‐sided colon cancer that were diverted received neoadjuvant chemotherapy.…”

Section: Discussionmentioning

confidence: 79%

Emergency resection or diverting stoma followed by elective resection in patients with colonic obstruction due to locally advanced cancer: a national cohort study

et al. 2021

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Aim The aim was to assess long‐term prognosis after emergency resection versus primary diverting stoma followed by elective tumour resection. Method A national‐register‐based cohort study with retrospective analysis of prospectively collected data was performed. All Swedish patients with non‐metastatic obstructive locally advanced colon cancer treated with emergency resection or diverting stoma, followed by an elective resection, between 2007 and 2017 were included. The Kaplan–Meier method and Cox proportional hazards model were used to compare all‐cause mortality between patients with emergency resection and elective right‐ and left‐sided resection. The multivariable model was adjusted for year of diagnosis, age at diagnosis, sex, Charlson Comorbidity Index, American Society of Anesthesiologists class, tumour location and pN stage. Results In all, 751 patients with a tumour in the right colon and 700 patients with a tumour in the left colon were included. Emergency resection was more common in patients with right‐sided colon tumours (681/751) than in patients with left‐sided colon tumours (483/700). The 5‐year overall survival in patients with right‐sided tumours was 25% after emergency resection and 46% after diverting stoma followed by elective resection (log‐rank test P = 0.001). The corresponding numbers for patients with left‐sided colon tumours were 40% and 64% (P < 0.001). Emergency resection was independently associated with increased all‐cause mortality in patients with left‐sided tumour (hazard ratio 1.63, 95% CI 1.21–2.19) but not in patients with right‐sided tumour (hazard ratio 1.21, 95% CI 0.80–1.81). Conclusion Diverting stoma followed by elective resection is associated with improved survival compared with emergency resection in patients with left‐sided colonic obstruction due to locally advanced tumours.

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Neoadjuvant chemotherapy does not increase risk for anastomotic leak for simultaneous resection of primary colon cancer with synchronous liver metastasis: A NSQIP‐colectomy analysis

Mankarious

Portolese

Hoskins

et al. 2023

Journal of Surgical Oncology

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Background and Objectives In patients with colon cancer with synchronous liver metastasis, treatment algorithms are complex and often require multidisciplinary evaluation. Neoadjuvant therapy is frequently utilized, but there is an unclear relationship with postoperative outcomes in patients with simultaneous resection. Methods This is a retrospective cohort study from the National Surgical Quality Improvement Program and Targeted Colectomy databases. All patients with stage IV colon cancer undergoing simultaneous colectomy with synchronous liver metastasis resection or ablation between 2015 and 2019 were identified and categorized into subgroups based on receipt of neoadjuvant chemotherapy. Multivariable logistic regression was utilized to assess for risk factors of anastomotic leaks and serious postoperative complications. Results We identified 1006 patients who underwent simultaneous colectomy and liver operations. Of those, 418 (41.6%) received neoadjuvant chemotherapy within 90 days of surgery, while 588 (58.4%) had simultaneous upfront surgery. On multivariable logistic regression, neoadjuvant therapy was not associated with postoperative anastomotic leaks (odds ratio [OR]: 1.30; p = 0.39) or serious complications (OR: 1.04; p = 0.82). Conclusion Neoadjuvant therapy does not increase postoperative complications in simultaneous colon and liver resections. These results may alleviate concerns regarding postoperative morbidity in the decision‐making process of administering neoadjuvant therapy.

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Neoadjuvant therapy in locally advanced colon cancer: a meta-analysis and systematic review

Cited by 62 publications

References 47 publications

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

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

Emergency resection or diverting stoma followed by elective resection in patients with colonic obstruction due to locally advanced cancer: a national cohort study

Neoadjuvant chemotherapy does not increase risk for anastomotic leak for simultaneous resection of primary colon cancer with synchronous liver metastasis: A NSQIP‐colectomy analysis

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