Current Controversies in the Management of Locally Advanced Colon Cancer

Gillani, Mishal; Rosen, Seth

doi:10.1177/00031348231175490

Cited by 2 publications

(3 citation statements)

References 74 publications

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“…Radiological staging was also found to be an independent predictor of long-term survival and was recommended for selecting patients with CC participating in clinical trials with NAC [42]. Magnetic resonance imaging allows a better soft tissue discrimination and diffusion-weighted imaging and may become an interesting complementary tool for the selection of patients [44].…”

Section: Discussionmentioning

confidence: 99%

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The ELECLA trial: A multicentre randomised control trial on outcomes of neoadjuvant treatment on locally advanced colon cancer

Arredondo,

Almeida,

Castañón

et al. 2024

Colorectal Disease

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BackgroundColon cancer (CC) is a public health concern with increasing incidence in younger populations. Treatment for locally advanced CC (LACC) involves oncological surgery and adjuvant chemotherapy (AC) to reduce recurrence and improve overall survival (OS). Neoadjuvant chemotherapy (NAC) is a novel approach for the treatment of LACC, and research is underway to explore its potential benefit in terms of survival. This trial will assess the efficacy of NAC in LACC.MethodsThis is a multicentre randomised, parallel‐group, open label controlled clinical trial. Participants will be selected based on homogenous inclusion criteria and randomly assigned to two treatment groups: NAC, surgery, and AC or surgery followed by AC. The primary aim of this study is to evaluate the 2‐year progression‐free survival (PFS), with secondary outcomes including 5‐year PFS, 2‐ and 5‐year OS, toxicity, radiological and pathological response, morbidity, and mortality.DiscussionThe results of this study will determine whether NAC induces a clinical and histological tumour response in patients with CCLA and if this treatment sequence improves survival without increasing morbidity and mortality.Registration numberNCT04188158.

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Section: Discussionmentioning

confidence: 99%

“…This study also highlights the importance of a multidisciplinary committee [56]. Recent meta-analyses have indicated that neoadjuvant treatment improves long-term surgical and oncological outcomes [28,57,58]; but the final role of NAC in LACC in the therapeutic guidelines remains unresolved [24,44,[59][60][61][62]. This is the reason…”

Section: Discussionmentioning

confidence: 99%

The ELECLA trial: A multicentre randomised control trial on outcomes of neoadjuvant treatment on locally advanced colon cancer

Arredondo,

Almeida,

Castañón

et al. 2024

Colorectal Disease

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“…These factors could potentially influence a tumour’s response to NAC and have an impact on survival. A further consideration is the need for accurate radiological staging to accurately identify patients who are suitable candidates for NAC 48 , 49 . The exploration of novel radiological findings, such as the emerging small arteriole sign, warrants meticulous consideration 50 .…”

Section: Discussionmentioning

confidence: 99%

Survival and safety after neoadjuvant chemotherapy or upfront surgery for locally advanced colon cancer: meta-analysis

Aliseda,

Arredondo,

Sánchez-Justicia

et al. 2024

British Journal of Surgery

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Background Neoadjuvant chemotherapy is increasingly used to treat locally advanced (T3–4 Nx–2 M0) colon cancer due to its potential advantages over the standard approach of upfront surgery. The primary objective of this systematic review and meta-analysis was to analyse data from comparative studies to assess the impact of neoadjuvant chemotherapy on oncological outcomes. Methods A systematic review was conducted by searching the MEDLINE and Scopus databases. The search encompassed RCTs, propensity score-matched studies, and controlled prospective studies published up to 1 April 2023. As a primary objective, overall survival and disease-free survival were compared. As a secondary objective, perioperative morbidity, mortality, and complete resection were compared using the DerSimonian and Laird models. Results A total of seven studies comprising a total of 2120 patients were included. Neoadjuvant chemotherapy was associated with a reduction in the hazard of recurrence (HR 0.73, 95% c.i. 0.59 to 0.90; P = 0.003) and death (HR 0.67, 95% c.i. 0.54 to 0.83; P < 0.001) compared with upfront surgery. Additionally, neoadjuvant chemotherapy was significantly associated with higher 5-year overall survival (79.9% versus 72.6%; P < 0.001) and disease-free survival (73.1% versus 64.5%; P = 0.028) rates. No significant differences were observed in perioperative mortality (OR 0.97, 95% c.i. 0.28 to 3.33), overall complications (OR 0.95, 95% c.i. 0.77 to 1.16), or anastomotic leakage/intra-abdominal abscess (OR 0.88, 95% c.i. 0.60 to 1.29). However, neoadjuvant chemotherapy was associated with a lower risk of incomplete resection (OR 0.70, 95% c.i. 0.49 to 0.99). Conclusion Neoadjuvant chemotherapy is associated with a reduced hazard of recurrence and death, as well as improved overall survival and disease-free survival rates, compared with upfront surgery in patients with locally advanced colon cancer.

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Current Controversies in the Management of Locally Advanced Colon Cancer

Abstract: n/a

Cited by 2 publications

References 74 publications

The ELECLA trial: A multicentre randomised control trial on outcomes of neoadjuvant treatment on locally advanced colon cancer

The ELECLA trial: A multicentre randomised control trial on outcomes of neoadjuvant treatment on locally advanced colon cancer

Survival and safety after neoadjuvant chemotherapy or upfront surgery for locally advanced colon cancer: meta-analysis

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