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

  • Original Research
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Journal of Gastrointestinal Surgery Aims and scope

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.

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References

  1. Croner RS, Merkel S, Papadopoulos T, Schellerer V, Hohenberger W, Goehl J. Multivisceral resection for colon carcinoma. Dis Colon Rectum 2009;52:1381–6.

    Article  PubMed  Google Scholar 

  2. Lehnert T, Methner M, Pollok A, Schaible A, Hinz U, Herfarth C. Multivisceral resection for locally advanced primary colon and rectal cancer: an analysis of prognostic factors in 201 patients. Ann Surg 2002;235:217–25.

    Article  PubMed  PubMed Central  Google Scholar 

  3. Gebhardt C, Meyer W, Ruckriegel S, Meier U. Multivisceral resection of advanced colorectal carcinoma. Langenbecks Arch Surg 1999;384:194–9.

    Article  PubMed  CAS  Google Scholar 

  4. Govindarajan A, Fraser N, Cranford V, Wirtzfeld D, Gallinger S, Law CH, Smith AJ, Gagliardi AR. Predictors of multivisceral resection in patients with locally advanced colorectal cancer. Ann Surg Oncol 2008;15:1923–30.

    Article  PubMed  PubMed Central  Google Scholar 

  5. Sauer R, Becker H, Hohenberger W, Rodel C, Wittekind C, Fietkau R, Martus P, Tschmelitsch J, Hager E, Hess CF, Karstens JH, Liersch T, Schmidberger H, Raab R, German Rectal Cancer Study G. Preoperative versus postoperative chemoradiotherapy for rectal cancer. N Engl J Med 2004;351:1731–40.

    Article  PubMed  CAS  Google Scholar 

  6. Ludmir EB, Arya R, Wu Y, Palta M, Willett CG, Czito BG. Role of Adjuvant Radiotherapy in Locally Advanced Colonic Carcinoma in the Modern Chemotherapy Era. Ann Surg Oncol 2016;23:856–62.

    Article  PubMed  Google Scholar 

  7. Martenson JA, Jr., Willett CG, Sargent DJ, Mailliard JA, Donohue JH, Gunderson LL, Thomas CR, Jr., Fisher B, Benson AB, 3rd, Myerson R, Goldberg RM. Phase III study of adjuvant chemotherapy and radiation therapy compared with chemotherapy alone in the surgical adjuvant treatment of colon cancer: results of intergroup protocol 0130. J Clin Oncol 2004;22:3277–83.

    Article  PubMed  CAS  Google Scholar 

  8. Willett CG, Fung CY, Kaufman DS, Efird J, Shellito PC. Postoperative radiation therapy for high-risk colon carcinoma. J Clin Oncol 1993;11:1112–7.

    Article  PubMed  CAS  Google Scholar 

  9. Cukier M, Smith AJ, Milot L, Chu W, Chung H, Fenech D, Herschorn S, Ko Y, Rowsell C, Soliman H, Ung YC, Wong CS. Neoadjuvant chemoradiotherapy and multivisceral resection for primary locally advanced adherent colon cancer: a single institution experience. Eur J Surg Oncol 2012;38:677–82.

    Article  PubMed  CAS  Google Scholar 

  10. Kuga Y, Tanaka T, Arita M, Okanobu H, Miwata T, Yoshimi S, Murakami E, Numata Y, Moriya T, Ohya T, Nishida T. [A case of effective chemotherapy using S-1 and CPT-11 following chemoradiotherapy with UFT and Leucovorin for unresectable advanced sigmoid colon cancer]. Gan To Kagaku Ryoho 2010;37:531–4.

    PubMed  Google Scholar 

  11. Mizukami H, Yoshizawa Y, Sasaya S, Nemoto H, Maezawa K, Sanada Y. [A case of advanced colon cancer invading the rectum effectively treated with chemoradiation therapy before surgery]. Gan To Kagaku Ryoho 2007;34:953–6.

    PubMed  Google Scholar 

  12. Taylor WE, Donohue JH, Gunderson LL, Nelson H, Nagorney DM, Devine RM, Haddock MG, Larson DR, Rubin J, O'Connell MJ. The Mayo Clinic experience with multimodality treatment of locally advanced or recurrent colon cancer. Ann Surg Oncol 2002;9:177–85.

    Article  PubMed  Google Scholar 

  13. Yoh T, Yamamichi K, Oishi M, Iwaki R, Motohiro T. [A case of effective neoadjuvant chemoradiotherapy with capecitabine for locally advanced sigmoid colon cancer]. Gan To Kagaku Ryoho 2011;38:1021–4.

    PubMed  Google Scholar 

  14. Benson AB, 3rd, Venook AP, Bekaii-Saab T, Chan E, Chen YJ, Cooper HS, Engstrom PF, Enzinger PC, Fenton MJ, Fuchs CS, Grem JL, Hunt S, Kamel A, Leong LA, Lin E, Messersmith W, Mulcahy MF, Murphy JD, Nurkin S, Rohren E, Ryan DP, Saltz L, Sharma S, Shibata D, Skibber JM, Sofocleous CT, Stoffel EM, Stotsky-Himelfarb E, Willett CG, Gregory KM, Freedman-Cass DA, National Comprehensive Cancer N. Colon cancer, version 3.2014. J Natl Compr Canc Netw 2014;12:1028–59.

    Article  PubMed  CAS  Google Scholar 

  15. Edge SB BD, Compton CC, Fritz AG, Greene FL, Trotti A, editors. AJCC cancer staging manual (7th ed). New York, NY: Springer, 2010.

    Google Scholar 

  16. Charlson ME, Pompei P, Ales KL, MacKenzie CR. A new method of classifying prognostic comorbidity in longitudinal studies: development and validation. J Chronic Dis 1987;40:373–83.

    Article  PubMed  CAS  Google Scholar 

  17. Dindo D, Demartines N, Clavien PA. Classification of surgical complications: a new proposal with evaluation in a cohort of 6336 patients and results of a survey. Ann Surg 2004;240:205–13.

    Article  PubMed  PubMed Central  Google Scholar 

  18. Gunderson LL, Jessup JM, Sargent DJ, Greene FL, Stewart AK. Revised TN categorization for colon cancer based on national survival outcomes data. J Clin Oncol 2010;28:264–71.

    Article  PubMed  Google Scholar 

  19. Govindarajan A, Coburn NG, Kiss A, Rabeneck L, Smith AJ, Law CH. Population-based assessment of the surgical management of locally advanced colorectal cancer. J Natl Cancer Inst 2006;98:1474–81.

    Article  PubMed  Google Scholar 

  20. Nakafusa Y, Tanaka T, Tanaka M, Kitajima Y, Sato S, Miyazaki K. Comparison of multivisceral resection and standard operation for locally advanced colorectal cancer: analysis of prognostic factors for short-term and long-term outcome. Dis Colon Rectum 2004;47:2055–63.

  21. Bosset JF, Collette L, Calais G, Mineur L, Maingon P, Radosevic-Jelic L, Daban A, Bardet E, Beny A, Ollier JC, Trial ERG. Chemotherapy with preoperative radiotherapy in rectal cancer. N Engl J Med 2006;355:1114–23.

    Article  PubMed  CAS  Google Scholar 

  22. Bujko K, Nowacki MP, Nasierowska-Guttmejer A, Michalski W, Bebenek M, Kryj M. Long-term results of a randomized trial comparing preoperative short-course radiotherapy with preoperative conventionally fractionated chemoradiation for rectal cancer. Br J Surg 2006;93:1215–23.

    Article  PubMed  CAS  Google Scholar 

  23. Gerard JP, Conroy T, Bonnetain F, Bouche O, Chapet O, Closon-Dejardin MT, Untereiner M, Leduc B, Francois E, Maurel J, Seitz JF, Buecher B, Mackiewicz R, Ducreux M, Bedenne L. Preoperative radiotherapy with or without concurrent fluorouracil and leucovorin in T3-4 rectal cancers: results of FFCD 9203. J Clin Oncol 2006;24:4620–5.

    Article  PubMed  Google Scholar 

  24. Kapiteijn E, Marijnen CA, Nagtegaal ID, Putter H, Steup WH, Wiggers T, Rutten HJ, Pahlman L, Glimelius B, van Krieken JH, Leer JW, van de Velde CJ, Dutch Colorectal Cancer G. Preoperative radiotherapy combined with total mesorectal excision for resectable rectal cancer. N Engl J Med 2001;345:638–46.

    Article  PubMed  CAS  Google Scholar 

  25. van Gijn W, Marijnen CA, Nagtegaal ID, Kranenbarg EM, Putter H, Wiggers T, Rutten HJ, Pahlman L, Glimelius B, van de Velde CJ, Dutch Colorectal Cancer G. Preoperative radiotherapy combined with total mesorectal excision for resectable rectal cancer: 12-year follow-up of the multicentre, randomised controlled TME trial. Lancet Oncol 2011;12:575–82.

    Article  PubMed  Google Scholar 

  26. 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  CAS  Google Scholar 

  27. Jakobsen A, Andersen F, Fischer A, Jensen LH, Jorgensen JC, Larsen O, Lindebjerg J, Ploen J, Rafaelsen SR, Vilandt J. Neoadjuvant chemotherapy in locally advanced colon cancer. A phase II trial. Acta Oncol 2015;54:1747–53.

    Article  PubMed  CAS  Google Scholar 

  28. Qiu B, Ding PR, Cai L, Xiao WW, Zeng ZF, Chen G, Lu ZH, Li LR, Wu XJ, Mirimanoff RO, Pan ZZ, Xu RH, Gao YH. Outcomes of preoperative chemoradiotherapy followed by surgery in patients with unresectable locally advanced sigmoid colon cancer. Chin J Cancer 2016;35.

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Author notes

  1. Drs. Mukkai Krishnamurty and Hawkins have contributed equally and are co-first authors.

Authors and Affiliations

  1. Division of General Surgery, Section of Colon and Rectal Surgery, Washington University School of Medicine, Washington University in St. Louis, 660 S. Euclid Avenue, St. Louis, MO, 63110, USA

    Devi Mukkai Krishnamurty, Alexander T. Hawkins, Katerina O. Wells, Matthew G. Mutch, Mathew L. Silviera, Sean C. Glasgow & Steven R. Hunt

  2. Division of General Surgery, Mercy Hospital, St. Louis, MO, USA

    Sekhar Dharmarajan

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  1. Devi Mukkai Krishnamurty
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Contributions

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.

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Correspondence to Sean C. Glasgow.

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Additional information

This paper was presented as a poster presentation at the 2016 Annual Scientific Meeting of the American Society of Colon & Rectal Surgeons, Los Angeles, CA, April 30,–May 4, 2016.

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Krishnamurty, D.M., Hawkins, A.T., Wells, K.O. et al. Neoadjuvant Radiation Therapy in Locally Advanced Colon Cancer: a Cohort Analysis. J Gastrointest Surg 22, 906–912 (2018). https://doi.org/10.1007/s11605-018-3676-2

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