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

Abstract

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.

Critical reappraisal of neoadjuvant concurrent chemoradiotherapy for treatment of locally advanced colon cancer

“…Nevertheless, our patients with pCR presented significantly longer OS but nearly the same DM control rates compared with patients without pCR. In our previous study of neoadjuvant CCRT for T4 CRC, patients with pCR exhibited better OS and DFS but without statistical significance [ 47 ]. Jalilian et al .…”

Weight Loss During Neoadjuvant Therapy Is Associated With Poor Response Among the Patients With Gastrointestinal Cancer: A Propensity Score Matching Analysis

“…In most recent studies, patients diagnosed with GC could benefit greatly from neoadjuvant therapy, and their local tumor control rate and overall survival were significantly improved. 29 – 31 However, this study focused on patients with resectable disease, with a selection of operative timing after neoadjuvant chemotherapy remaining controversial. For these patients, we hope to provide a more accessible and earlier predictor for the response to neoadjuvant treatment and survival than imaging.…”

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“…Increasing evidence and accumulating data indicate that T4 might have a worse outcome than that of T1-3 disease, which means that within T4 diseases, there would be a wider invasion of visceral peritoneum or pelvic organs (like the bladder, uterus, prostate gland or the cervix), more chances to invade the blood vessels, lymph-vessels or the nerves, and more possibly to metastasize [14][15] compared with T1-3 diseases. Worstly, if the tumor has locally or distant metastasis, the survival outcome would become poorer., where several studies have supported this theory already.…”