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Mid-term oncologic outcome of a novel approach for locally advanced colon cancer with neoadjuvant chemotherapy and surgery

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Abstract

Purpose

Neoadjuvant chemotherapy is being actively tested as an emerging alternative for the treatment of locally advanced colon cancer (LACC) patients, resembling its use in other gastrointestinal tumors. This study assesses the mid-term oncologic outcome of LACC patients treated with oxaliplatin and fluoropyrimidines-based preoperative chemotherapy followed by surgery.

Methods and patients

Patients with radiologically resectable LACC treated with neoadjuvant therapy between 2009 and 2014 were retrospectively analyzed. Radiological, metabolic, and pathological tumor response was assessed. Both postoperative complications, relapse-free survival (RFS), and overall survival (OS) were studied.

Results

Sixty-five LACC patients who received treatment were included. Planned treatment was completed by 93.8 % of patients. All patients underwent surgery without delay. The median time between the start of chemotherapy and surgery was 71 days (65–82). No progressive disease was observed during preoperative treatment. A statistically significant tumor volume reduction of 62.5 % was achieved by CT scan (39.8–79.8) (p < 0.001). It was also observed a median reduction of 40.5 % (24.2–63.7 %) (p < 0.005) of SUVmax (Standard Uptake Value) by PET-CT scan. Complete pathologic response was achieved in 4.6 % of patients. Postoperative complications were observed in 15.4 % of patients, with no cases of mortality. After a median follow-up of 40.1 months, (p 25–p 75: 27.3–57.8) 3–5 year actuarial RFS was 88.9–85.6 %, respectively. Five-year actuarial OS was 95.3 %.

Conclusion

Preoperative chemotherapy in LACC patients is safe and able to induce major tumor regression. Survival times are encouraging, and further research seems warranted.

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References

  1. Ferlay J, Shin HR, Bray F, Forman D, Mathers C, Parkin DM. Estimates of worldwide burden of cancer in 2008: GLOBOCAN 2008. Int J Cancer. 2010;127:2893–917.

    Article  CAS  PubMed  Google Scholar 

  2. Benson AB 3rd, Schrag D, Somerfield MR, Cohen AM, Figueredo AT, Flynn PJ, et al. American Society of Clinical Oncology recommendations on adjuvant chemotherapy for stage II colon cancer. J Clin Oncol. 2004;22:3408–19.

    Article  PubMed  Google Scholar 

  3. Edge SB, Byrd DR, Compton CC, Fritz AG, Greene FL, Trotti A. AJCC cancer staging manual (7th ed). New York: Springer; 2010.

    Google Scholar 

  4. Kim MJ, Jeong SY, Choi SJ, Ryoo SB, Park JW, Park KJ, et al. Survival paradox between stage IIB/C (T4N0) and stage IIIA (T1-2N1) colon cancer. Ann Surg Oncol. 2015;22:505–12.

    Article  PubMed  Google Scholar 

  5. Allegra CJ, Yothers G, O’Connell MJ, Sharif S, Petrelli NJ, Colangelo LH, et al. Phase III trial assessing bevacizumab in stages II and III carcinoma of the colon: results of NSABP protocol C-08. J Clin Oncol. 2011;29:11–6.

    Article  CAS  PubMed  Google Scholar 

  6. Alberts SR, Sargent DJ, Nair S, Mahoney MR, Mooney M, Thibodeau SN, et al. Effect of oxaliplatin, fluorouracil, and leucovorin with or without cetuximab on survival among patients with resected stage III colon cancer: a randomized trial. JAMA. 2012;307:1383–93.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  7. Foxtrot Collaborative G. Feasibility of preoperative chemotherapy for locally advanced, operable colon cancer: the pilot phase of a randomised controlled trial. Lancet Oncol. 2012;13:1152–60.

    Article  Google Scholar 

  8. Jakobsen A, Andersen F, Fischer A, Jensen LH, Jørgensen JC, Larsen O, et al. Neoadjuvant chemotherapy in locally advanced colon cancer. A phase II trial. Acta Oncol. 2015;29:1–7.

    Google Scholar 

  9. Sauer R, Becker H, Hohenberger W, Rödel C, Wittekind C, Fietkau R, et al. Preoperative versus postoperative chemoradiotherapy for rectal cancer. N Engl J Med. 2004;351:1731–40.

    Article  CAS  PubMed  Google Scholar 

  10. Hendren S, Birkmeyer JD, Yin H, Banerjee M, Sonnenday C, Morris AM. Surgical complications are associated with omission of chemotherapy for stage III colorectal cancer. Dis Colon Rectum. 2010;53:1587–93.

    Article  PubMed  Google Scholar 

  11. Arredondo J, Pastor C, Baixauli J, Rodríguez J, González I, Vigil C, et al. Preliminary outcome of a treatment strategy based on perioperative chemotherapy and surgery in patients with locally advanced colon cancer. Colorectal Dis. 2013;15:552–7.

    Article  CAS  PubMed  Google Scholar 

  12. Young H, Baum R, Cremerius U, Herholz K, Hoekstra O, Lammertsma AA, et al. Measurement of clinical and subclinical tumour response using [18F]-fluorodeoxyglucose and positron emission tomography: review and 1999 EORTC recommendations. European Organization for Research and Treatment of Cancer (EORTC) PET Study Group. Eur J Cancer. 1999;35:1773–82.

    Article  CAS  PubMed  Google Scholar 

  13. Shia J, Guillem JG, Moore HG, Tickoo SK, Qin J, Ruo L, et al. Patterns of morphologic alteration in residual rectal carcinoma following preoperative chemoradiation and their association with long-term outcome. Am J Surg Pathol. 2004;28:215–23.

    Article  PubMed  Google Scholar 

  14. Iachetta F, Reggiani Bonetti L, Marcheselli L, Di Gregorio C, Crilli C, Messinese S, et al. Lymph node evaluation in stage IIA colorectal cancer and its impact on patient prognosis: a population-based study. Acta Oncol. 2013;52:1682–90.

    Article  CAS  PubMed  Google Scholar 

  15. Arredondo J, Martínez P, Baixauli J, Pastor C, Rodríguez J, Pardo F, et al. Analysis of surgical complications of primary tumor resection after neoadjuvant treatment in stage IV colon cancer. J Gastrointest Oncol. 2014;5:148–53.

    PubMed  PubMed Central  Google Scholar 

  16. Maas M, Nelemans PJ, Valentini V, Das P, Rödel C, Kuo LJ, et al. Long-term outcome in patients with a pathological complete response after chemoradiation for rectal cancer: a pooled analysis of individual patient data. Lancet Oncol. 2010;11:835–44.

    Article  PubMed  Google Scholar 

  17. Cienfuegos JA, Rotellar F, Baixauli J, Beorlegui C, Sola JJ, Arbea L, et al. Impact of perineural and lymphovascular invasion on oncological outcomes in rectal cancer treated with neoadjuvant chemoradiotherapy and surgery. Ann Surg Oncol. 2015;22:916–23.

    Article  CAS  PubMed  Google Scholar 

  18. Dighe S, Swift I, Magill L, Handley K, Gray R, Quirke P, et al. Accuracy of radiological staging in identifying high-risk colon cancer patients suitable for neoadjuvant chemotherapy: a multicentre experience. Colorectal Dis. 2012;14:438–44.

    Article  CAS  PubMed  Google Scholar 

  19. Smith NJ, Bees N, Barbachano Y, Norman AR, Swift RI, Brown G, et al. Preoperative computed tomography staging of nonmetastatic colon cancer predicts outcome: implications for clinical trials. Br J Cancer. 2007;96:1030–6.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  20. Arredondo J, González I, Baixauli J, et al. Tumor response assessment in locally advanced colon cancer after neoadjuvant chemotherapy. J Gastrointest Oncol. 2014;5:104–11.

    PubMed  PubMed Central  Google Scholar 

  21. Huh JW, Jeong YY, Kim HR, Kim YJ. Prognostic value of preoperative radiological staging assessed by computed tomography in patients with nonmetastatic colon cancer. Ann Oncol. 2012;23:1198–206.

    Article  CAS  PubMed  Google Scholar 

  22. Hendlisz A, Golfinopoulos V, Deleporte A, Paesmans M, El Mansy H, Garcia C, et al. Preoperative chemosensitivity testing as predictor of treatment benefit in adjuvant stage III colon cancer (PePiTA): protocol of a prospective BGDO (Belgian Group for Digestive Oncology) multicentric study. BMC Cancer. 2013;13:190.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  23. Cervantes A. Preoperative chemotherapy for colon cancer is getting closer. Lancet Oncol. 2012;13:1073–4.

    Article  PubMed  Google Scholar 

  24. Zhou Z, Nimeiri HS, Benson AB 3rd. Preoperative chemotherapy for locally advanced resectable colon cancer—a new treatment paradigm in colon cancer? Ann Transl Med. 2013;1:11.

    PubMed  PubMed Central  Google Scholar 

  25. Mayor S. Chemotherapy before surgery for colon cancer may improve survival, study shows. BMJ. 2012;345:e7487.

    Article  PubMed  Google Scholar 

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Author information

Authors and Affiliations

  1. Department of General Surgery, Complejo Asistencial Universitario de León, c/Altos de Nava s/n, 24008, León, Spain

    J. Arredondo

  2. Department of General Surgery, Clínica Universidad de Navarra, Pamplona, Spain

    J. Baixauli, J. A-Cienfuegos & J. L. Hernández-Lizoain

  3. Department of General Surgery, Fundación Jiménez-Díaz, Madrid, Spain

    C. Pastor

  4. Department of Medical Oncology, Clínica Universidad de Navarra, Pamplona, Spain

    A. Chopitea & J. Rodriguez

  5. Department of Pathology, Hospital San Pedro, Logroño, Spain

    J. J. Sola

  6. Department of Radiology, Clínica Universidad de Navarra, Pamplona, Spain

    I. González

  7. Department of General Surgery, Centro Médico de Asturias, Oviedo, Spain

    P. Martínez

Authors
  1. J. Arredondo
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  2. J. Baixauli
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  3. C. Pastor
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  4. A. Chopitea
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  5. J. J. Sola
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  6. I. González
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  7. J. A-Cienfuegos
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  8. P. Martínez
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  9. J. Rodriguez
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  10. J. L. Hernández-Lizoain
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Corresponding author

Correspondence to J. Arredondo.

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Conflict of interest

The authors declare that they have no conflict of interest.

Ethical standards

The study protocol was approved by the local Institutional Review Board Committee and all patients signed informed consent.

Funding support

None.

Additional information

Both J. Rodriguez and J. L. Hernández-Lizoain are Senior Authors.

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Arredondo, J., Baixauli, J., Pastor, C. et al. Mid-term oncologic outcome of a novel approach for locally advanced colon cancer with neoadjuvant chemotherapy and surgery. Clin Transl Oncol 19, 379–385 (2017). https://doi.org/10.1007/s12094-016-1539-4

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  • DOI: https://doi.org/10.1007/s12094-016-1539-4

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