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Journal of Gastrointestinal Surgery

, Volume 22, Issue 5, pp 906–912 | Cite as

Neoadjuvant Radiation Therapy in Locally Advanced Colon Cancer: a Cohort Analysis

  • Devi Mukkai Krishnamurty
  • Alexander T. Hawkins
  • Katerina O. Wells
  • Matthew G. Mutch
  • Mathew L. Silviera
  • Sean C. Glasgow
  • Steven R. Hunt
  • Sekhar Dharmarajan
Original Research

Abstract

Background

A paucity of data exists in the use of neoadjuvant chemoradiation therapy (NRT) for T4, non-metastatic colon cancer. This study was conducted to determine the effect of NRT on outcomes after resection for T4 colon cancer.

Methods

All patients with non-metastatic resected clinical T4 colon cancer from 2000 to 2012 at a tertiary care center were included. The cohort was divided into two groups—those that received NRT and those that did not (non-NRT). The primary outcomes were margin-negative resection and overall survival (OS).

Results

One hundred and thirty-one consecutive patients with non-metastatic clinical T4 colon cancer with a mean age of 65 years were included. NRT was used in 23 patients (17.4%). NRT group was noted to have non-statistically significant improvement in R0 resection rate (NRT 95.7% vs non-NRT 88.0%; p = 0.27) and local recurrence (NRT 4.3% vs non-NRT 15.7%; p = 0.15). There was a significant difference in T-stage downstaging between the two groups (NRT 30.4% vs non-NRT 6.5%; p = 0.007). In a bivariate analysis, NRT was associated with improved 5-year OS (NRT 76.4% vs non-NRT 51.5%; p = 0.03). This relationship did not persist in a Cox proportional hazard analysis that included age and comorbidity (HR 2.19; 95% CI 0.87–5.52; p = 0.09).

Conclusions

The use of NRT in locally advanced T4 colon cancer is safe and associated with increased downstaging. While there was a trend toward improvement in local recurrence and the ability to obtain margin-negative resections in the NRT group, this was not significant. Significantly improved overall survival was not observed in a multivariable analysis.

Keywords

Locally advanced colon cancer Radiotherapy Surgery Outcomes Adenocarcinoma 

Notes

Authors’ Contribution

All authors have provided substantial contributions to the conception or design of the work; or the acquisition, analysis, or interpretation of data for the work, drafted the work or revised it critically for important intellectual content, approved the version to be published, and agreed to be accountable for all aspects of the work in ensuring that questions related to the accuracy or integrity of any part of the work are appropriately investigated and resolved.

Compliance with Ethical Standards

Funding information

Departmental

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Copyright information

© The Society for Surgery of the Alimentary Tract 2018

Authors and Affiliations

  • Devi Mukkai Krishnamurty
    • 1
  • Alexander T. Hawkins
    • 1
  • Katerina O. Wells
    • 1
  • Matthew G. Mutch
    • 1
  • Mathew L. Silviera
    • 1
  • Sean C. Glasgow
    • 1
  • Steven R. Hunt
    • 1
  • Sekhar Dharmarajan
    • 2
  1. 1.Division of General Surgery, Section of Colon and Rectal Surgery, Washington University School of MedicineWashington University in St. LouisSt. LouisUSA
  2. 2.Division of General SurgeryMercy HospitalSt. LouisUSA

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