Neoadjuvant chemoradiotherapy followed by surgery in patients with unresectable locally advanced colon cancer: a prospective observational study
Received 30 August 2017
Accepted for publication 10 December 2017
Published 17 January 2018 Volume 2018:11 Pages 409—418
Checked for plagiarism Yes
Review by Single anonymous peer review
Peer reviewer comments 4
Editor who approved publication: Prof. Dr. Jianmin Xu
Hui Chang,1,2,* Xin Yu,1,2,* Wei-wei Xiao,1,2 Qiao-xuan Wang,1,2 Wen-hao Zhou,1,3 Zhi-fan Zeng,1,2 Pei-rong Ding,1,3 Li-ren Li,1,3 Yuan-hong Gao1,2
1State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Guangzhou, China; 2Department of Radiation Oncology, Sun Yat-sen University Cancer Center, Guangzhou, China; 3Department of Colorectal Surgery, Sun Yat-sen University Cancer Center, Guangzhou, China
*These authors contributed equally to this work
Background: The 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 methods: We 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, downstage 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.
Results: A 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%.
Conclusion: NACRT 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.
Keywords: colon cancer, unresectable disease, R0 resection, complete response, survival
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