Neoadjuvant chemoradiotherapy followed by surgery in patients with unresectable locally advanced colon cancer: a prospective observational study

Hui Chang, Xin Yu, Wei-Wei Xiao, Qiao-Xuan Wang, Wen-Hao Zhou, Zhi-Fan Zeng, Pei-Rong Ding, Li-Ren Li, Yuan-Hong Gao, Hui Chang, Xin Yu, Wei-Wei Xiao, Qiao-Xuan Wang, Wen-Hao Zhou, Zhi-Fan Zeng, Pei-Rong Ding, Li-Ren Li, Yuan-Hong Gao

Abstract

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, down-stage 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: R0 resection; colon cancer; complete response; survival; unresectable disease.

Conflict of interest statement

Disclosure The authors report no conflicts of interest in this work.

Figures

Figure 1
Figure 1
Stage transfer of the 60 patients with unresectable colon cancer. Notes: Finally, 57 out of the 60 patients received surgery after NACRT. The pretreatment cTNM stage of the 60 patients treated with NACRT and postsurgical pTNM stage of the 57 patients receiving surgery were evaluated. Abbreviations: cTNM, clinical TNM; NACRT, neoadjuvant chemoradiotherapy; pTNM, pathologic TNM.
Figure 2
Figure 2
Survival curves of the 60 patients with unresectable colon cancer. Notes: (A) Overall survival; (B) disease-free survival; (C) distant-metastasis-free survival; (D) local-recurrence-free survival.

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