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Sökning: WFRF:(West Andy) > (2023) > Preoperative Chemot...

  • Morton, DionUniv Hosp Birmingham, Birmingham, England. (författare)

Preoperative Chemotherapy for Operable Colon Cancer : Mature Results of an International Randomized Controlled Trial

  • Artikel/kapitelEngelska2023

Förlag, utgivningsår, omfång ...

  • American Society of Clinical Oncology (ASCO),2023
  • printrdacarrier

Nummerbeteckningar

  • LIBRIS-ID:oai:DiVA.org:uu-506410
  • https://urn.kb.se/resolve?urn=urn:nbn:se:uu:diva-506410URI
  • https://doi.org/10.1200/JCO.22.00046DOI

Kompletterande språkuppgifter

  • Språk:engelska
  • Sammanfattning på:engelska

Ingår i deldatabas

Klassifikation

  • Ämneskategori:ref swepub-contenttype
  • Ämneskategori:art swepub-publicationtype

Anmärkningar

  • 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.

Ämnesord och genrebeteckningar

Biuppslag (personer, institutioner, konferenser, titlar ...)

  • Seymour, MatthewSt James Univ Hosp, Leeds, England. (författare)
  • Magill, LauraUniv Birmingham Clin Trials Unit, Birmingham, England. (författare)
  • Handley, KellyUniv Birmingham Clin Trials Unit, Birmingham, England. (författare)
  • Glasbey, JamesUniv Hosp Birmingham, Birmingham, England. (författare)
  • Glimelius, Bengt (författare)
  • Palmer, AndyUniv Birmingham Clin Trials Unit, Birmingham, England. (författare)
  • Seligmann, JennySt James Univ Hosp, Leeds, England. (författare)
  • Laurberg, SorenAarhus Univ, Aarhus, Denmark. (författare)
  • Murakami, KeigoUniv Leeds, Sch Med, Div Pathol & Data Analyt, Leeds, England. (författare)
  • West, NickUniv Leeds, Sch Med, Div Pathol & Data Analyt, Leeds, England. (författare)
  • Quirke, PhilipUniv Leeds, Sch Med, Div Pathol & Data Analyt, Leeds, England. (författare)
  • Gray, RichardUniv Oxford, Nuffield Dept Populat Hlth, Oxford, England. (författare)
  • Grp, FOxTROT Collaborative (författare)
  • Univ Hosp Birmingham, Birmingham, England.St James Univ Hosp, Leeds, England. (creator_code:org_t)

Sammanhörande titlar

  • Ingår i:Journal of Clinical Oncology: American Society of Clinical Oncology (ASCO)41:8, s. 1541-+0732-183X1527-7755

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