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

Autor: Mathew L. Silviera, Katerina O. Wells, Sean C. Glasgow, Steven R. Hunt, Devi Mukkai Krishnamurty, Sekhar Dharmarajan, Alexander T. Hawkins, Matthew G. Mutch
Rok vydání: 2018
Předmět:
Adult
Male
Oncology
medicine.medical_specialty
Neoplasm
Residual
Colorectal cancer
medicine.medical_treatment
Locally advanced
Comorbidity
behavioral disciplines and activities
Young Adult
03 medical and health sciences
0302 clinical medicine
health services administration
Internal medicine
mental disorders
medicine
Humans
030212 general & internal medicine
health care economics and organizations
Aged
Neoplasm Staging
Proportional Hazards Models
Retrospective Studies
Aged
80 and over
business.industry
Significant difference
Age Factors
Gastroenterology
Margins of Excision
Chemoradiotherapy
Adjuvant
Middle Aged
medicine.disease
Neoadjuvant Therapy
Survival Rate
Radiation therapy
030220 oncology & carcinogenesis
Colonic Neoplasms
Cohort
behavior and behavior mechanisms
Adenocarcinoma
Female
Surgery
Neoplasm Recurrence
Local
business
Cohort study
Zdroj: Journal of Gastrointestinal Surgery. 22:906-912
ISSN: 1873-4626
1091-255X
DOI: 10.1007/s11605-018-3676-2
Popis: 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. 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). 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). 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.
Databáze: OpenAIRE
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