Neoadjuvant chemoradiotherapy for patients with unresectable radically locally advanced colon cancer: a potential improvement to overall survival and decrease to multivisceral resection

Yan Yuan, Wei-Wei Xiao, Wei-Hao Xie, Pei-Qiang Cai, Qiao-Xuan Wang, Hui Chang, Bao-Qing Chen, Wen-Hao Zhou, Zhi-Fan Zeng, Xiao-Jun Wu, Qing Liu, Li-Ren Li, Rong Zhang, Yuan-Hong Gao, Yan Yuan, Wei-Wei Xiao, Wei-Hao Xie, Pei-Qiang Cai, Qiao-Xuan Wang, Hui Chang, Bao-Qing Chen, Wen-Hao Zhou, Zhi-Fan Zeng, Xiao-Jun Wu, Qing Liu, Li-Ren Li, Rong Zhang, Yuan-Hong Gao

Abstract

Background: The management of unresectable locally advanced colon cancer (LACC) remains controversial, as resection is not feasible. The goal of this study was to evaluate the treatment outcomes and toxicity of neoadjuvant chemoradiotherapy (NACRT) followed with surgery and adjuvant chemotherapy in patients with unresectable radically LACC.

Methods: We included patients who were diagnosed at our institution, 2010-2018. The neoadjuvant regimen consisted of radiotherapy and capecitabine/ 5-fluorouracil-based chemotherapy.

Results: One hundred patients were identified. The median follow-up time was 32 months. The R0 resection rate, adjusted nonmultivisceral resection rate and bladder preservation rate were 83.0, 43.0 and 83.3%, respectively. The pCR and clinical-downstaging rates were 18, and 81.0%%, respectively. The 3-year PFS and OS rates for all patients were 68.6 and 82.1%, respectively. Seventeen patients developed grade 3-4 myelosuppression, which was the most common adverse event observed after NACRT. Tumor perforation occurred in 3 patients during NACRT. The incidence of grade 3-4 surgery-related complications was 7.0%. Postoperative anastomotic leakage was observed in 3 patients.

Conclusions: NACRT followed by surgery was feasible and safe for selected patients with LACC, and can be used as a conversion treatment to achieve satisfactory downstaging, long-term survival and quality of life, with acceptable toxicities.

Keywords: Locally advanced colon cancer; Neoadjuvant chemoradiotherapy; Organ preservation; Pathological complete response.

Conflict of interest statement

The authors report no conflicts of interest.

Figures

Fig. 1
Fig. 1
Flowchart of diagnosis of unresectable LACC (a) and Study profile (b). NACRT, Neoadjuvant chemoradiotherapy; EL, exploratory laparotomy; CME, complete mesocolic excision; MVR, multivisceral resection
Fig. 2
Fig. 2
Changes in the imaging features of patients with T4b tumors after neoadjuvant radiotherapy and chemotherapy. a Imaging figures presented ascending colon cancer with invasion of ileum (yellow arrow) and lymph node metastasis with invasion of parietal peritoneum (blue arrow). After NACRT, ascending colon cancer and lymph node metastasis were obviously smaller than before NACRT; b Imaging figures showed sigmoid colon cancer with invasion of bladder (brown arrow), small intestinal (yellow arrow) and peritoneum (blue arrow). Sigmoid colon cancer shrank significantly after NACRT
Fig. 3
Fig. 3
Survival curves. OS and PFS curves of all patients (a). PFS curves (b) and OS curves (c) curves of the patients with unresectable LACC by resection group (R0 vs R2 vs NRS). P values were calculated from the comparison between the groups. NRS: Nonresectable surgery

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Source: PubMed

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