nach oben

Erschienen in:

20.09.2017 | 2017 SSAT Plenary Presentation

Neoadjuvant Chemotherapy Improves Survival in Patients with Clinical T4b Colon Cancer

verfasst von: Ahmed Dehal, Amanda N. Graff-Baker, Brooke Vuong, Trevan Fischer, Samuel J. Klempner, Shu-Ching Chang, Gary L. Grunkemeier, Anton J. Bilchik, Melanie Goldfarb

Erschienen in: Journal of Gastrointestinal Surgery | Ausgabe 2/2018

Einloggen, um Zugang zu erhalten

Abstract

Background

In 2016, the National Comprehensive Cancer Network included neoadjuvant chemotherapy as a treatment option for patients with clinical T4b colon cancer. However, there is little published data on the survival impact of neoadjuvant chemotherapy for locally advanced colon cancer.

Methods

Adult patients with non-metastatic clinically staged T3 or T4 colon cancer who underwent surgical resection were identified from the National Cancer Data Base between 2006 and 2014. Treatment was categorized as neoadjuvant chemotherapy followed by surgery and surgery followed by adjuvant chemotherapy. Overall survival was compared between the two groups using propensity score matching.

Results

Of 27,575 patients that met inclusion criteria, 26,654 (97%) were treated with surgery followed by adjuvant chemotherapy and 921 (3%) received neoadjuvant chemotherapy followed by surgery. After propensity score matching, patients with T4b colon cancer treated with neoadjuvant chemotherapy had a 23% lower risk of death at 3 years compared to patients that had adjuvant chemotherapy (HR 0.77, 95% CI 0.60–0.98; p = 0.04). However, neoadjuvant chemotherapy did not demonstrate a similar significant benefit for patients with T3 and T4a disease.

Conclusions

Patients with clinical T4b colon cancer treated with neoadjuvant chemotherapy may have an improved survival compared to those who receive adjuvant chemotherapy. Further prospective investigation is warranted.

Z. Zhou, H. S. Nimeiri, and A. B. Benson, “Preoperative chemotherapy for locally advanced resectable colon cancer—a new treatment paradigm in colon cancer?,” Ann. Transl. Med., vol. 1, no. 2, p. 11, 2013.PubMedPubMedCentral

D. A. Agbamu et al., “Feasibility of preoperative chemotherapy for locally advanced, operable colon cancer: The pilot phase of a randomised controlled trial,” Lancet Oncol., vol. 13, no. 11, pp. 1152–1160, 2012.CrossRef

T. André et al., “Improved overall survival with oxaliplatin, fluorouracil, and leucovorin as adjuvant treatment in stage II or III colon cancer in the MOSAIC trial.,” J. Clin. Oncol., vol. 27, no. 19, pp. 3109–16, 2009.CrossRefPubMed

T. Lehnert, M. Methner, A. Pollok, A. Schaible, U. Hinz, and C. Herfarth, “Multivisceral resection for locally advanced primary colon and rectal cancer: an analysis of prognostic factors in 201 patients.,” Ann. Surg., vol. 235, no. 2, pp. 217–25, 2002.CrossRefPubMedPubMedCentral

R. S. Croner, S. Merkel, T. Papadopoulos, V. Schellerer, W. Hohenberger, and J. Goehl, “Multivisceral resection for colon carcinoma,” Dis. Colon rectum, vol. 52, no. 8, pp. 1381–1386, 2009.CrossRefPubMed

Medical Research Council Oesophageal Cancer Working Party*, “Surgical resection with or without preoperative chemotherapy in oesophageal cancer: a randomised controlled trial.,” Lancet, vol. 359, no. 9319, pp. 1727–33, 2002.CrossRef

D. Cunningham et al., “Perioperative chemotherapy versus surgery alone for resectable gastroesophageal cancer,” N Engl J Med, vol. 355, no. 1, pp. 11–20, 2006.CrossRefPubMed

D. Sebag-Montefiore et al., “Preoperative radiotherapy versus selective postoperative chemoradiotherapy in patients with rectal cancer (MRC CR07 and NCIC-CTG C016): a multicentre, randomised trial,” Lancet, vol. 373, no. 9666, pp. 811–820, 2009.CrossRefPubMedPubMedCentral

K. Tanaka et al., “Metastatic Tumor Doubling Time: Most Important Prehepatectomy Predictor of Survival and Nonrecurrence of Hepatic Colorectal Cancer Metastasis,” World J. Surg., vol. 28, no. 3, pp. 263–270, 2004.CrossRefPubMed

10.

H. Nelson et al., “Guidelines 2000 for colon and rectal cancer surgery,” J Natl Cancer Inst, vol. 93, no. 8, pp. 583–596, 2001.CrossRefPubMed

11.

P. J. Guillou et al., “Short-term endpoints of conventional versus laparoscopic-assisted surgery in patients with colorectal cancer (MRC CLASICC trial): Multicentre, randomised controlled trial,” Lancet, vol. 365, no. 9472, pp. 1718–1726, 2005.CrossRefPubMed

12.

A. Jakobsen et al., “Neoadjuvant chemotherapy in locally advanced colon cancer. A phase II trial.,” Acta Oncol., vol. 54, no. 10, pp. 1747–1753, 2015.CrossRefPubMed

13.

NCCN, “NCCN Clinical Practice Guidelines in Oncology (NCCN Guidelines®) Colon Cancer,” Version 1.2017, 2016.

14.

University of Birmingham. Fluorouracil and Oxaliplatin With or Without Panitumumab In Treating Patients With High-Risk Colon Cancer That Can Be Removed by Surgery. Available at https://clinicaltrials.gov/

15.

F. Lordick et al., “PET to assess early metabolic response and to guide treatment of adenocarcinoma of the oesophagogastric junction: the MUNICON phase II trial,” Lancet Oncol., vol. 8, no. 9, pp. 797–805, 2007.CrossRefPubMed

16.

L. E. McCahill et al., “Primary mFOLFOX6 plus bevacizumab without resection of the primary tumor for patients presenting with surgically unresectable metastatic colon cancer and an intact asymptomatic colon cancer: Definitive analysis of NSABP Trial C-10,” J. Clin. Oncol., vol. 30, no. 26, pp. 3223–3228, 2012.

17.

N. J. Smith, N. Bees, Y. Barbachano, A. R. Norman, R. I. Swift, and G. Brown, “Preoperative computed tomography staging of nonmetastatic colon cancer predicts outcome: implications for clinical trials.,” Br. J. Cancer, vol. 96, no. 7, pp. 1030–6, 2007.CrossRefPubMedPubMedCentral

18.

T. Yoh, K. Yamamichi, M. Oishi, R. Iwaki, and T. Motohiro, “[A case of effective neoadjuvant chemoradiotherapy with capecitabine for locally advanced sigmoid colon cancer].,” Gan To Kagaku Ryoho., vol. 38, no. 6, pp. 1021–1024, 2011.PubMed

19.

M. Yoshitomi, H. Hashida, A. Nomura, S. Ueda, H. Terajima, and N. Osaki, “[A case of locally advanced sigmoid colon cancer treated with neoadjuvant chemoradiotherapy].,” Gan To Kagaku Ryoho., vol. 41, no. 9, pp. 1175–1178, 2014.PubMed

20.

H. Mizukami, Y. Yoshizawa, S. Sasaya, H. Nemoto, K. Maezawa, and Y. Sanada, “[A case of advanced colon cancer invading the rectum effectively treated with chemoradiation therapy before surgery],” Gan To Kagaku Ryoho, vol. 34, no. 6, pp. 953–956, 2007.PubMed

21.

M. Cukier et al., “Neoadjuvant chemoradiotherapy and multivisceral resection for primary locally advanced adherent colon cancer: A single institution experience,” European Journal of Surgical Oncology, vol. 38, no. 8. pp. 677–682, 2012.CrossRefPubMed

22.

S. Burton et al., “MRI identified prognostic features of tumors in distal sigmoid, rectosigmoid, and upper rectum: Treatment with radiotherapy and chemotherapy,” Int. J. Radiat. Oncol. Biol. Phys., vol. 65, no. 2, pp. 445–451, 2006.CrossRefPubMed

23.

H. Zhou et al., “A pilot phase II study of neoadjuvant triplet chemotherapy regimen in patients with locally advanced resectable colon cancer,” Chinese J. Cancer Res., vol. 28, no. 6, pp. 598–605, 2016.CrossRef

24.

F. Liu et al., “CapOX as neoadjuvant chemotherapy for locally advanced operable colon cancer patients: a prospective single-arm phase II trial,” Chinese J. Cancer Res., vol. 28, no. 6, pp. 589–597, 2016.CrossRef

25.

M. Karoui et al., “Neoadjuvant FOLFOX 4 versus FOLFOX 4 with Cetuximab versus immediate surgery for high-risk stage II and III colon cancers: a multicentre randomised controlled phase II trial—the PRODIGE 22--ECKINOXE trial.,” BMC Cancer, vol. 15, p. 511, 2015.CrossRefPubMedPubMedCentral

Titel: Neoadjuvant Chemotherapy Improves Survival in Patients with Clinical T4b Colon Cancer
verfasst von: Ahmed Dehal
Amanda N. Graff-Baker
Brooke Vuong
Trevan Fischer
Samuel J. Klempner
Shu-Ching Chang
Gary L. Grunkemeier
Anton J. Bilchik
Melanie Goldfarb
Publikationsdatum: 20.09.2017
Verlag: Springer US
Erschienen in: Journal of Gastrointestinal Surgery / Ausgabe 2/2018
Print ISSN: 1091-255X
Elektronische ISSN: 1873-4626
DOI: https://doi.org/10.1007/s11605-017-3566-z

Neu im Fachgebiet Chirurgie

23.04.2024 | Ablationstherapie | Nachrichten

Wie erfolgreich ist eine Re-Ablation nach Rezidiv?

23.04.2024 | Appendizitis | Nachrichten

Hinter dieser Appendizitis steckte ein Erreger

23.04.2024 | Operationsvorbereitung | Nachrichten

Mehr Schaden als Nutzen durch präoperatives Aussetzen von GLP-1-Agonisten?

19.04.2024 | EAU 2024 | Kongressbericht | Nachrichten

Ureterstriktur: Innovative OP-Technik bewährt sich

weitere anzeigen

Update Chirurgie

Bestellen Sie unseren Fach-Newsletter und bleiben Sie gut informiert.

Newsletter bestellen

Aktuelle BDC Leitlinien-Webinare

S3-Leitlinie „Diagnostik und Therapie des Karpaltunnelsyndroms“

Karpaltunnelsyndrom BDC Leitlinien Webinare

CME: 2 Punkte

Das Karpaltunnelsyndrom ist die häufigste Kompressionsneuropathie peripherer Nerven. Obwohl die Anamnese mit dem nächtlichen Einschlafen der Hand (Brachialgia parästhetica nocturna) sehr typisch ist, ist eine klinisch-neurologische Untersuchung und Elektroneurografie in manchen Fällen auch eine Neurosonografie erforderlich. Im Anfangsstadium sind konservative Maßnahmen (Handgelenksschiene, Ergotherapie) empfehlenswert. Bei nicht Ansprechen der konservativen Therapie oder Auftreten von neurologischen Ausfällen ist eine Dekompression des N. medianus am Karpaltunnel indiziert.

Prof. Dr. med. Gregor Antoniadis

S2e-Leitlinie „Distale Radiusfraktur“

Radiusfraktur BDC Leitlinien Webinare

CME: 2 Punkte

Das Webinar beschäftigt sich mit Fragen und Antworten zu Diagnostik und Klassifikation sowie Möglichkeiten des Ausschlusses von Zusatzverletzungen. Die Referenten erläutern, welche Frakturen konservativ behandelt werden können und wie. Das Webinar beantwortet die Frage nach aktuellen operativen Therapiekonzepten: Welcher Zugang, welches Osteosynthesematerial? Auf was muss bei der Nachbehandlung der distalen Radiusfraktur geachtet werden?

PD Dr. med. Oliver Pieske

Dr. med. Benjamin Meyknecht

S1-Leitlinie „Empfehlungen zur Therapie der akuten Appendizitis bei Erwachsenen“

Appendizitis BDC Leitlinien Webinare

CME: 2 Punkte

Inhalte des Webinars zur S1-Leitlinie „Empfehlungen zur Therapie der akuten Appendizitis bei Erwachsenen“ sind die Darstellung des Projektes und des Erstellungswegs zur S1-Leitlinie, die Erläuterung der klinischen Relevanz der Klassifikation EAES 2015, die wissenschaftliche Begründung der wichtigsten Empfehlungen und die Darstellung stadiengerechter Therapieoptionen.

Dr. med. Mihailo Andric

Springer Medizin

Abstract

Background

Methods

Results

Conclusions

Bitte loggen Sie sich ein, um Zugang zu diesem Inhalt zu erhalten

Weitere Artikel der Ausgabe 2/2018

Common Hepatic Artery Abutment or Encasement Is an Adverse Prognostic Factor in Patients with Borderline and Unresectable Pancreatic Cancer

Is Neoadjuvant Therapy Sufficient in Resected Pancreatic Cancer Patients? A National Study

Resection of Locally Advanced Pancreatic Cancer without Regression of Arterial Encasement After Modern-Era Neoadjuvant Therapy

Attempting a Laparoscopic Approach in Patients Undergoing Left-Sided Colorectal Surgery Who Have Had a Previous Laparotomy: Is it Feasible?

Intraductal Papillary Mucinous Neoplasm of the Pancreas in Young Patients: Tumor Biology, Clinical Features, and Survival Outcomes

Optimal Therapy in Locally Advanced Esophageal Cancer: a National Cancer Database Analysis

Neu im Fachgebiet Chirurgie

Wie erfolgreich ist eine Re-Ablation nach Rezidiv?

Hinter dieser Appendizitis steckte ein Erreger

Mehr Schaden als Nutzen durch präoperatives Aussetzen von GLP-1-Agonisten?

Ureterstriktur: Innovative OP-Technik bewährt sich

Update Chirurgie

Aktuelle BDC Leitlinien-Webinare

S3-Leitlinie „Diagnostik und Therapie des Karpaltunnelsyndroms“

S2e-Leitlinie „Distale Radiusfraktur“

S1-Leitlinie „Empfehlungen zur Therapie der akuten Appendizitis bei Erwachsenen“