Published online Dec 15, 2020. doi: 10.4251/wjgo.v12.i12.1428
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
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.
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.
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.
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.
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.
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.
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.