Observational Study
Copyright ©The Author(s) 2020. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Gastrointest Oncol. Dec 15, 2020; 12(12): 1428-1442
Published online Dec 15, 2020. doi: 10.4251/wjgo.v12.i12.1428
Outcomes of neoadjuvant chemoradiotherapy followed by radical resection for T4 colorectal cancer
Chun-Ming Huang, Ching-Wen Huang, Cheng-Jen Ma, Hsiang-Lin Tsai, Wei-Chih Su, Tsung-Kun Chang, Ming-Yii Huang, Jaw Yuan Wang
Chun-Ming Huang, Ming-Yii Huang, Department of Radiation Oncology, Kaohsiung Medical University Hospital, Kaohsiung 80145, Taiwan
Ching-Wen Huang, Hsiang-Lin Tsai, Department of Surgery, Kaohsiung Medical University Hospital, Kaohsiung Medical University, Kaohsiung 80145, Taiwan
Cheng-Jen Ma, Wei-Chih Su, Tsung-Kun Chang, Division of Colorectal Surgery, Department of Surgery, Kaohsiung Medical University Hospital, Kaohsiung 80145, Taiwan
Jaw Yuan Wang, Department of Surgery and Cancer Center, Kaohsiung Medical University Hospital, Kaohsiung Medical University, Kaohsiung 80708, Taiwan
Author contributions: Wang JY and Huang MY contributed equally to this paper; Wang JY conceived the concept of the study and supervised the study; Huang CM wrote and drafted the manuscript; Huang CW, Ma CJ, Tsai HL, Su WC, and Chang TK collected and collated the clinical data; Huang MY and Huang CM conducted the statistical analysis and interpreted the results; all authors read and approved the final manuscript.
Supported by the grants through funding from the Ministry of Science and Technology, No. MOST109-2314-B-037-035, No. MOST109-2314-B-037-040, and No. MOST109-2314-B-037-046-MY3; the Ministry of Health and Welfare funded by Health and Welfare Surcharge of Tobacco Products, No. MOHW109-TDU-B-212-124026; the Kaohsiung Medical University Hospital and the Kaohsiung Municipal Ta-Tung Hospital, No. S10903, No. KMUH108-8R34, No. KMUH108-8R35, No. KMUH108-8M33, No. KMUH108-8M35, No. KMUH108-8M36, No. KMUH-DK109003, and No. KMUH-DK109005-3.
Institutional review board statement: This study was approved by the Institutional Review Board of Kaohsiung Medical University Hospital (KMUHIRB-EII-20190281).
Informed consent statement: The informed consent was waived.
Conflict-of-interest statement: The authors declare that they have no conflicts of interest to disclose.
Data sharing statement: There are no additional data.
STROBE statement: All authors have read the STROBE statement checklist of items. The manuscript was prepared and revised according to the STROBE statement checklist of items.
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: Jaw Yuan Wang, MD, PhD, Professor, Department of Surgery and Cancer Center, Kaohsiung Medical University Hospital, Kaohsiung Medical University, No. 100 Tz-You 1st Road, Kaohsiung 80708, Taiwan. cy614112@ms14.hinet.net
Received: August 26, 2020
Peer-review started: August 26, 2020
First decision: October 21, 2020
Revised: November 10, 2020
Accepted: November 17, 2020
Article in press: November 17, 2020
Published online: December 15, 2020
Processing time: 106 Days and 6.3 Hours
ARTICLE HIGHLIGHTS
Research background

Patients diagnosed with clinical T4 colorectal cancer are at high risk of recurrence because of difficulty in achieving free surgical margins. Multi-visceral resection is needed for the complete resection of the disease.

Research motivation

Patients diagnosed with clinical T4 colorectal cancer are at high risk of recurrence because of difficulty in achieving free surgical margins. Multi-visceral resection is needed for the complete resection of the disease.

Research objectives

Patients diagnosed with clinical T4 colorectal cancer are at high risk of recurrence because of difficulty in achieving free surgical margins. Multi-visceral resection is needed for the complete resection of the disease.

Research methods

We retrospectively reviewed colorectal cancer (CRC) patients from the database of The Kaohsiung Medical University Hospital from August 2010 to September 2018. Eighty-six patients who completed neoadjuvant chemoradiation and radical resection were enrolled for analysis. The neoadjuvant regimens in this study were capecitabine plus radiotherapy, and FOLFOX plus radiotherapy. The radiation dose was 45 to 50.4 Gy with a daily fraction of 1.8 or 2 Gy. We used multivariate logistic regression analysis to identify independent predictors of pathological complete response (pCR). Using Kaplan-Meier method and log-rank test, we measured the disease-free survival (DFS) and overall survival (OS) between groups, where multivariate Cox proportional hazard models were used to analyze the impact of pCR and resection margins as prognostic factors.

Research results

The rates of pCR and R0 resection were 14% and 91.9%, respectively. Nineteen patients (22.1%) developed distant metastases and local recurrence was found in 13 patients (15.1%). Patients who underwent FOLFOX plus radiotherapy were more likely to achieve pCR compared to those who received capecitabine plus radiotherapy (P = 0.046). Multivariate analysis revealed that an R0 resection was associated with favorable DFS (P = 0.014) and OS (P = 0.001), and the pCR group obtained better DFS (P = 0.042) and OS (P = 0.003) than the non-pCR group.

Research conclusions

Neoadjuvant chemoradiation results in high rates of pCR and complete resection for patients with T4 CRC. R0 resection and pCR are significant predictors of favorable survival.

Research perspectives

Neoadjuvant chemoradiation should be considered as one of the treatment options in T4 colon and rectal cancer. Further prospective randomized studies are warranted to validate our results.