The latest research from Fudan Cancer Hospital: "Delayed surgery after neoadjuvant radiotherapy and chemotherapy" is not applicable to all colon cancer patients | Standard | Auxiliary

Release time:Apr 13, 2024 21:09 PM

Recently, it was reported that Professor Li Xinxiang from the Department of Colorectal Surgery at Fudan University Affiliated Cancer Hospital led a team to publish a research result confirming that "delayed surgery after neoadjuvant radiotherapy and chemotherapy" as the standard treatment plan is not universally applicable to all locally advanced colon cancer patients.

Research has shown that patients with locally advanced colon cancer who experience poor tumor regression after neoadjuvant radiotherapy and chemotherapy have poorer survival benefits with longer preoperative intervals. These patients should be screened in a timely manner to avoid delaying surgery. The relevant research results have been published in the internationally authoritative academic journal International Surgery, with an impact factor of 13.4.

Colon cancer is one of the most common malignant tumors in China, seriously threatening the lives and health of residents. Surgical intervention is an important means for colon cancer patients to achieve curative treatment. Data shows that over 80% of colon cancer patients are already in the advanced stage at initial diagnosis and cannot undergo surgery directly. Fortunately, for patients with locally advanced colon cancer, surgery opportunities can still be obtained after neoadjuvant radiotherapy and chemotherapy. This is also the standard treatment for locally advanced colon cancer at present.

According to current international diagnostic and treatment guidelines, patients with locally advanced colon cancer should undergo surgical treatment after receiving neoadjuvant radiotherapy and chemotherapy at an interval of 5-12 weeks. "The purpose of delayed surgery is to enable patients to better regress their tumor lesions after receiving neoadjuvant radiotherapy and chemotherapy, in order to achieve better surgical results. Especially for patients with good tumor regressions confirmed by postoperative pathology, this plan can improve treatment effectiveness and effectively reduce the risk of anal preservation failure," said Li Xinxiang. "However, not all locally advanced colon cancer patients can benefit from delayed surgery. Some patients with poor tumor regressions may increase the risk of positive margins and anal preservation failure due to delayed surgery."

Which patients can delay surgery and which are not suitable? Therefore, Professor Li Xinxiang's team conducted project research. The study included data from 522 rectal cancer patients admitted to oncology hospitals between 2010 and 2018 who underwent neoadjuvant chemotherapy and had a postoperative pathological confirmed TRG score of 2-3.

Retrospective analysis showed that patients were divided into short interval group and long interval group based on the surgical interval. Further research has found that both univariate and multivariate results suggest that patients in the long interval group have shorter overall survival and disease-free survival compared to those in the short interval group. The 3-year disease-free survival rates in the short interval group and long interval group are 75.6% and 63.1%, respectively. This means that for locally advanced colon cancer patients with mild or no tumor regression after neoadjuvant chemotherapy, the longer the preoperative interval, the poorer the survival benefits.

Experts say that some patients are not suitable for the standard delayed surgical plan and should be screened in a timely manner to choose other more suitable treatment methods. If the R0 resection standard can be achieved after 8 weeks of receiving conversion therapy, even if the tumor regression is not ideal, it is not recommended to continue with neoadjuvant therapy. Surgical treatment should be chosen as soon as possible. If the tumor regresses poorly and cannot achieve R0 resection, it is necessary to initiate immunotherapy or targeted therapy combined with chemotherapy to gain more opportunities for patients. It is worth noting that the duration of this conversion therapy generally does not exceed 16 weeks.

Dr. Luo Dakui from Fudan University Affiliated Cancer Hospital is the first author of the research findings, and Professor Li Xinxiang/Professor Li Qingguo from the Department of Colorectal Surgery at Fudan University Affiliated Cancer Hospital are the corresponding authors and co corresponding authors.

Why is "Cancer King" immunotherapy ineffective? Fudan Cancer Hospital Reveals New Mechanisms of Immunosuppressive Environment for pancreatic cancer CRIP1 | Tumor | pancreatic cancer
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A 14-year-old girl suffers from a rare eye disease and receives support from a public welfare fund. Symptoms of "I haven't looked in the mirror for a long time" | Patient | Public welfare
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A 14-year-old girl has been experiencing symptoms such as protruding pupils, incomplete eye closure, corneal injury, restricted eye movement, and overall fatigue for several years. The physical discomfort and facial abnormalities caused by eye diseases have made her increasingly reticent, and her temperament is vastly different from before. At the Ophthalmology Department of the Ninth People's Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, the pupil has been diagnosed with a rare thyroid ophthalmopathy combined with myasthenia gravis, which requires prompt treatment. However, considering the young age of the pupil, conventional hormone and radiation therapy cannot be used. Therefore, Zhou Huifang, Deputy Director of Ophthalmology and thyroid ophthalmology expert, has developed a targeted drug combined with surgical treatment plan for it, and targeted drug treatment will be performed first. Three months ago, I was hospitalized for one week with mydriasis and received intravenous targeted drug treatment. Afterwards, I went home for observation and followed up on time

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The Ninth Hospital has taken the lead in formulating the world's first consensus on core indicators for clinical evaluation of dental implants, which has been officially published in clinical practice
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Recently, Catherine, a British girl born in the 1990s, received autologous peripheral blood hematopoietic stem cell transfusion at the Cancer Center of Shanghai Jiahui International Hospital, and was successfully discharged from the warehouse. She is now on her way back to China after being discharged from the hospital. She is also the first patient at Shanghai Jiahui International Hospital to complete relevant treatments. In 2019, Catherine was diagnosed with Hodgkin's lymphoma in the UK, and after treatment, the disease completely improved. During her work and life in China in 2021, she went to seek medical attention due to multiple enlarged lymph nodes. Pathological biopsy confirmed a recurrence of Hodgkin's lymphoma, and through combined targeted drug treatment, her condition was temporarily under control. Last year in the second half of the year, when the disease recurred, the girl began to use immunotherapy combined with targeted drugs for treatment. Expert evaluation suggests that for young patients with hematological tumors, the risk of recurrence is high and treatment difficulty is increasing in the future. Autologous hematopoietic stem cell therapy is recommended