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Preoperative Chemot...
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Morton, DionUniv Hosp Birmingham, Birmingham, England.
(author)
Preoperative Chemotherapy for Operable Colon Cancer : Mature Results of an International Randomized Controlled Trial
- Article/chapterEnglish2023
Publisher, publication year, extent ...
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American Society of Clinical Oncology (ASCO),2023
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LIBRIS-ID:oai:DiVA.org:uu-506410
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https://urn.kb.se/resolve?urn=urn:nbn:se:uu:diva-506410URI
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https://doi.org/10.1200/JCO.22.00046DOI
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Language:English
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Summary in:English
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Subject category:ref swepub-contenttype
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Subject category:art swepub-publicationtype
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PURPOSE: Neoadjuvant chemotherapy (NAC) has potential advantages over standard postoperative chemotherapy for locally advanced colon cancer but requires formal evaluation.METHODS: Patients with radiologically staged T3-4, N0-2, M0 colon cancer were randomly allocated (2:1) to 6 weeks oxaliplatin-fluoropyrimidine preoperatively plus 18 postoperatively (NAC group) or 24 weeks postoperatively (control group). Patients with RAS-wildtype tumors could also be randomly assigned 1:1 to receive panitumumab or not during NAC. The primary end point was residual disease or recurrence within 2 years. Secondary outcomes included surgical morbidity, histopathologic stage, regression grade, completeness of resection, and cause-specific mortality. Log-rank analyses were by intention-to-treat.RESULTS: Of 699 patients allocated to NAC, 674 (96%) started and 606 (87%) completed NAC. In total, 686 of 699 (98.1%) NAC patients and 351 of 354 (99.2%) control patients underwent surgery. Thirty patients (4.3%) allocated to NAC developed obstructive symptoms requiring expedited surgery, but there were fewer serious postoperative complications with NAC than with control. NAC produced marked T and N downstaging and histologic tumor regression (all P < .001). Resection was more often histopathologically complete: 94% (648/686) versus 89% (311/351), P < .001. Fewer NAC than control patients had residual or recurrent disease within 2 years (16.9% [118/699] v 21.5% [76/354]; rate ratio, 0.72 [95% CI, 0.54 to 0.98]; P = .037). Tumor regression correlated strongly with freedom from recurrence. Panitumumab did not enhance the benefit from NAC. Little benefit from NAC was seen in mismatch repair-deficient tumors.CONCLUSION: Six weeks of preoperative oxaliplatin-fluoropyrimidine chemotherapy for operable colon cancer can be delivered safely, without increasing perioperative morbidity. This chemotherapy regimen, when given preoperatively, produces marked histopathologic down-staging, fewer incomplete resections, and better 2-year disease control. Histologic regression after NAC is a strong predictor of lower postoperative recurrence risk so has potential use as a guide for postoperative therapy. Six weeks of NAC should be considered as a treatment option for locally advanced colon cancer.
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Seymour, MatthewSt James Univ Hosp, Leeds, England.
(author)
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Magill, LauraUniv Birmingham Clin Trials Unit, Birmingham, England.
(author)
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Handley, KellyUniv Birmingham Clin Trials Unit, Birmingham, England.
(author)
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Glasbey, JamesUniv Hosp Birmingham, Birmingham, England.
(author)
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Glimelius, Bengt
(author)
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Palmer, AndyUniv Birmingham Clin Trials Unit, Birmingham, England.
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Seligmann, JennySt James Univ Hosp, Leeds, England.
(author)
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Laurberg, SorenAarhus Univ, Aarhus, Denmark.
(author)
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Murakami, KeigoUniv Leeds, Sch Med, Div Pathol & Data Analyt, Leeds, England.
(author)
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West, NickUniv Leeds, Sch Med, Div Pathol & Data Analyt, Leeds, England.
(author)
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Quirke, PhilipUniv Leeds, Sch Med, Div Pathol & Data Analyt, Leeds, England.
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Gray, RichardUniv Oxford, Nuffield Dept Populat Hlth, Oxford, England.
(author)
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Grp, FOxTROT Collaborative
(author)
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Univ Hosp Birmingham, Birmingham, England.St James Univ Hosp, Leeds, England.
(creator_code:org_t)
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In:Journal of Clinical Oncology: American Society of Clinical Oncology (ASCO)41:8, s. 1541-+0732-183X1527-7755
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Morton, Dion
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Seymour, Matthew
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Magill, Laura
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Handley, Kelly
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Glasbey, James
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Glimelius, Bengt
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Palmer, Andy
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Seligmann, Jenny
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Laurberg, Soren
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Murakami, Keigo
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West, Nick
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Quirke, Philip
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Gray, Richard
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Grp, FOxTROT Col ...
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Uppsala University