Outcomes of preoperative chemoradiotherapy followed by surgery in patients with unresectable locally advanced sigmoid colon cancer

Bo Qiu, Pei-Rong Ding, Ling Cai, Wei-Wei Xiao, Zhi-Fan Zeng, Gong Chen, Zhen-Hai Lu, Li-Ren Li, Xiao-Jun Wu, Rene-Olivier Mirimanoff, Zhi-Zhong Pan, Rui-Hua Xu, Yuan-Hong Gao, Bo Qiu, Pei-Rong Ding, Ling Cai, Wei-Wei Xiao, Zhi-Fan Zeng, Gong Chen, Zhen-Hai Lu, Li-Ren Li, Xiao-Jun Wu, Rene-Olivier Mirimanoff, Zhi-Zhong Pan, Rui-Hua Xu, Yuan-Hong Gao

Abstract

Background: Complete resection of locally advanced sigmoid colon cancer (LASCC) is sometimes difficult. Patients with LASCC have a dismal prognosis and poor quality of life, which has encouraged the evaluation of alternative multimodality treatments. This prospective study aimed to assess the feasibility and efficacy of neoadjuvant chemoradiotherapy (neoCRT) followed by surgery as treatment of selected patients with unresectable LASCC.

Methods: We studied the patients with unresectable LASCC who received neoCRT followed by surgery between October 2010 and December 2012. The neoadjuvant regimen consisted of external-beam radiotherapy to 50 Gy and capecitabine-based chemotherapy every 3 weeks. Surgery was scheduled 6-8 weeks after radiotherapy.

Results: Twenty-one patients were included in this study. The median follow-up was 42 months (range, 17-57 months). All patients completed neoCRT and surgery. Resection with microscopically negative margins (R0 resection) was achieved in 20 patients (95.2%). Pathologic complete response was observed in 8 patients (38.1%). Multivisceral resection was necessary in only 7 patients (33.3%). Two patients (9.5%) experienced grade 2 postoperative complications. No patients died within 30 days after surgery. For 18 patients with pathologic M0 (ypM0) disease, the cumulative probability of 3-year local recurrence-free survival, disease-free survival and overall survival was 100.0%, 88.9% and 100.0%, respectively. For all 21 patients, the cumulative probability of 3-year overall survival was 95.2% and bladder function was well preserved.

Conclusion: For patients with unresectable LASCC, preoperative chemoradiotherapy and surgery can be performed safely and may result in an increased survival rate.

Keywords: Down-staging; Neoadjuvant chemoradiotherapy; Organ preservation; R0 resection; Unresectable locally advanced sigmoid colon cancer.

Figures

Fig. 1
Fig. 1
The magnetic resonance imaging (MRI) scans prior to neoadjuvant chemoradiotherapy (neoCRT), after neoCRT and after colectomy in a patient with unresectable locally advanced sigmoid colon cancer (LASCC). MRI scan of the lower abdomen and pelvis before neoCRT (a–c), 4 weeks after neoCRT (d–f) and 1 month after surgical resection (g–i) show the lesion. Prior to neoCRT, the lesion measured 100 mm at the largest dimension and invaded into the urinary bladder (long arrow). The radial margins are at risk (a–c). After neoCRT, substantial down-sizing of the lesion and improvement of all the margins were observed. The upper bladder wall (short arrow) remains thick (d–f). After colectomy and partial cystectomy, the lesion was removed completely. Bladder structure is well preserved (arrow head) (g–i). (a, d, g, coronal T1-weighted with contrast; b, e, h, sagittal T1-weighted with contrast; c, f, i, cross T2-weighted)
Fig. 2
Fig. 2
The pathologic findings before neoCRT and after surgery of a patient with LASCC (hematoxylin and eosin staining). a, b Pathologic examination of the sigmoid colon biopsy before neoCRT shows typical features of a well-differentiated adenocarcinoma: hyperplastic glandular structures lined by atypical epithelial cells. Mitotic figures are observed. c Postoperative pathologic examination shows lymphoid infiltrates in intestinal mucosa. No malignant cells are observed
Fig. 3
Fig. 3
Disease-free survival (DFS) curve of the 18 patients with ypM0 (pathologic M0) sigmoid colon cancer. DFS was calculated by using Life Table methods. The cumulative probability for 3-year DFS rate was 88.9%

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