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Outcomes of neoadjuvant chemoradiotherapy followed by radical resection for T4 colorectal cancer

BACKGROUND: 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. AIM: To evaluate tumor downsizing and resection wi...

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Autores principales: Huang, Chun-Ming, Huang, Ching-Wen, Ma, Cheng-Jen, Tsai, Hsiang-Lin, Su, Wei-Chih, Chang, Tsung-Kun, Huang, Ming-Yii, Wang, Jaw Yuan
Formato: Online Artículo Texto
Lenguaje:English
Publicado: Baishideng Publishing Group Inc 2020
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7739149/
https://www.ncbi.nlm.nih.gov/pubmed/33362913
http://dx.doi.org/10.4251/wjgo.v12.i12.1428
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author Huang, Chun-Ming
Huang, Ching-Wen
Ma, Cheng-Jen
Tsai, Hsiang-Lin
Su, Wei-Chih
Chang, Tsung-Kun
Huang, Ming-Yii
Wang, Jaw Yuan
author_facet Huang, Chun-Ming
Huang, Ching-Wen
Ma, Cheng-Jen
Tsai, Hsiang-Lin
Su, Wei-Chih
Chang, Tsung-Kun
Huang, Ming-Yii
Wang, Jaw Yuan
author_sort Huang, Chun-Ming
collection PubMed
description BACKGROUND: 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. AIM: To evaluate tumor downsizing and resection with clear margins in T4 CRC patients undergoing neoadjuvant concurrent chemoradiotherapy followed by surgery. METHODS: 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. RESULTS: 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. CONCLUSION: 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.
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spelling pubmed-77391492020-12-24 Outcomes of neoadjuvant chemoradiotherapy followed by radical resection for T4 colorectal cancer Huang, Chun-Ming Huang, Ching-Wen Ma, Cheng-Jen Tsai, Hsiang-Lin Su, Wei-Chih Chang, Tsung-Kun Huang, Ming-Yii Wang, Jaw Yuan World J Gastrointest Oncol Observational Study BACKGROUND: 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. AIM: To evaluate tumor downsizing and resection with clear margins in T4 CRC patients undergoing neoadjuvant concurrent chemoradiotherapy followed by surgery. METHODS: 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. RESULTS: 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. CONCLUSION: 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. Baishideng Publishing Group Inc 2020-12-15 2020-12-15 /pmc/articles/PMC7739149/ /pubmed/33362913 http://dx.doi.org/10.4251/wjgo.v12.i12.1428 Text en ©The Author(s) 2020. Published by Baishideng Publishing Group Inc. All rights reserved. http://creativecommons.org/licenses/by-nc/4.0/ This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/Licenses/by-nc/4.0/
spellingShingle Observational Study
Huang, Chun-Ming
Huang, Ching-Wen
Ma, Cheng-Jen
Tsai, Hsiang-Lin
Su, Wei-Chih
Chang, Tsung-Kun
Huang, Ming-Yii
Wang, Jaw Yuan
Outcomes of neoadjuvant chemoradiotherapy followed by radical resection for T4 colorectal cancer
title Outcomes of neoadjuvant chemoradiotherapy followed by radical resection for T4 colorectal cancer
title_full Outcomes of neoadjuvant chemoradiotherapy followed by radical resection for T4 colorectal cancer
title_fullStr Outcomes of neoadjuvant chemoradiotherapy followed by radical resection for T4 colorectal cancer
title_full_unstemmed Outcomes of neoadjuvant chemoradiotherapy followed by radical resection for T4 colorectal cancer
title_short Outcomes of neoadjuvant chemoradiotherapy followed by radical resection for T4 colorectal cancer
title_sort outcomes of neoadjuvant chemoradiotherapy followed by radical resection for t4 colorectal cancer
topic Observational Study
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7739149/
https://www.ncbi.nlm.nih.gov/pubmed/33362913
http://dx.doi.org/10.4251/wjgo.v12.i12.1428
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