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