Outcomes of neoadjuvant chemoradiotherapy followed by radical resection for T4 colorectal cancer
Open Access
- 15 December 2020
- journal article
- research article
- Published by Baishideng Publishing Group Inc. in World Journal of Gastrointestinal Oncology
- Vol. 12 (12), 1428-1442
- https://doi.org/10.4251/wjgo.v12.i12.1428
Abstract
Patients with clinical T4 colorectal cancer (CRC) have a poor prognosis because of compromised surgical margins. Neoadjuvant therapy may be effective in downstaging tumors, thereby rendering possible radical resection with clear margins. To evaluate tumor downsizing and resection with clear margins in T4 CRC patients undergoing neoadjuvant concurrent chemoradiotherapy followed by surgery. This study retrospectively included 86 eligible patients with clinical T4 CRC who underwent neoadjuvant concurrent chemoradiotherapy followed by radical resection. Neoadjuvant therapy consisted of radiation therapy at a dose of 45-50.4 Gy and chemotherapy agents, either FOLFOX or capecitabine. A circumferential resection margin (CRM) of < 1 mm was considered to be a positive margin. We defined pathological complete response (pCR) as the absence of any malignant cells in a specimen, including the primary tumor and lymph nodes. A multivariate logistic regression model was used to identify independent predictive factors for pCR. For 86 patients who underwent neoadjuvant chemoradiotherapy and surgery, the rate of pCR was 14%, and the R0 resection rate was 91.9%. Of the 61 patients with rectal cancer, 7 (11.5%) achieved pCR and 5 (8.2%) had positive CRMs. Of the 25 patients with colon cancer, 5 (20%) achieved pCR and 2 (8%) had positive CRMs. We observed that the FOLFOX regimen was an independent predictor of pCR (P = 0.046). After a median follow-up of 47 mo, the estimated 5-year overall survival (OS) and disease-free survival (DFS) rates were 70.8% and 61.4%, respectively. Multivariate analysis revealed that a tumor with a negative resection margin was associated with improved DFS (P = 0.014) and OS (P = 0.001). Patients who achieved pCR exhibited longer DFS (P = 0.042) and OS (P = 0.003) than those who did not. Neoadjuvant concurrent chemoradiotherapy engenders favorable pCR and R0 resection rates among patients with T4 CRC. The R0 resection rate and pCR are independent prognostic factors for patients with T4 CRC.Keywords
This publication has 37 references indexed in Scilit:
- Clinical Prediction of Pathological Complete Response After Preoperative Chemoradiotherapy for Rectal CancerDiseases of the Colon & Rectum, 2013
- Preoperative chemoradiotherapy and postoperative chemotherapy with fluorouracil and oxaliplatin versus fluorouracil alone in locally advanced rectal cancer: initial results of the German CAO/ARO/AIO-04 randomised phase 3 trialThe Lancet Oncology, 2012
- Primary Tumor Response to Preoperative Chemoradiation With or Without Oxaliplatin in Locally Advanced Rectal Cancer: Pathologic Results of the STAR-01 Randomized Phase III TrialJournal of Clinical Oncology, 2011
- Optimal Timing of Surgery After Chemoradiation for Advanced Rectal CancerAnnals of Surgery, 2011
- Analysis of the Prognostic Effectiveness of a Multivisceral Resection for Locally Advanced Colorectal CancerJournal of the Korean Society of Coloproctology, 2011
- Comparison of Two Neoadjuvant Chemoradiotherapy Regimens for Locally Advanced Rectal Cancer: Results of the Phase III Trial ACCORD 12/0405-Prodige 2Journal of Clinical Oncology, 2010
- Preoperative Multimodality Therapy Improves Disease-Free Survival in Patients With Carcinoma of the Rectum: NSABP R-03Journal of Clinical Oncology, 2009
- Multivisceral Resection for Colon CarcinomaDiseases of the Colon & Rectum, 2009
- Predictors of Multivisceral Resection in Patients with Locally Advanced Colorectal CancerAnnals of Surgical Oncology, 2008
- Population-Based Assessment of the Surgical Management of Locally Advanced Colorectal CancerJNCI Journal of the National Cancer Institute, 2006