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Preoperative Chemot...
Preoperative Chemotherapy for Operable Colon Cancer : Mature Results of an International Randomized Controlled Trial
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- Morton, Dion (författare)
- Univ Hosp Birmingham, Birmingham, England.
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- Seymour, Matthew (författare)
- St James Univ Hosp, Leeds, England.
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- Magill, Laura (författare)
- Univ Birmingham Clin Trials Unit, Birmingham, England.
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- Handley, Kelly (författare)
- Univ Birmingham Clin Trials Unit, Birmingham, England.
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- Glasbey, James (författare)
- Univ Hosp Birmingham, Birmingham, England.
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Glimelius, Bengt (författare)
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- Palmer, Andy (författare)
- Univ Birmingham Clin Trials Unit, Birmingham, England.
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- Seligmann, Jenny (författare)
- St James Univ Hosp, Leeds, England.
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- Laurberg, Soren (författare)
- Aarhus Univ, Aarhus, Denmark.
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- Murakami, Keigo (författare)
- Univ Leeds, Sch Med, Div Pathol & Data Analyt, Leeds, England.
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- West, Nick (författare)
- Univ Leeds, Sch Med, Div Pathol & Data Analyt, Leeds, England.
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- Quirke, Philip (författare)
- Univ Leeds, Sch Med, Div Pathol & Data Analyt, Leeds, England.
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- Gray, Richard (författare)
- Univ Oxford, Nuffield Dept Populat Hlth, Oxford, England.
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Grp, FOxTROT Collaborative (författare)
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Univ Hosp Birmingham, Birmingham, England St James Univ Hosp, Leeds, England. (creator_code:org_t)
- American Society of Clinical Oncology (ASCO), 2023
- 2023
- Engelska.
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Ingår i: Journal of Clinical Oncology. - : American Society of Clinical Oncology (ASCO). - 0732-183X .- 1527-7755. ; 41:8, s. 1541-
- Relaterad länk:
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https://urn.kb.se/re...
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https://doi.org/10.1...
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Abstract
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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.
Ämnesord
- MEDICIN OCH HÄLSOVETENSKAP -- Klinisk medicin -- Cancer och onkologi (hsv//swe)
- MEDICAL AND HEALTH SCIENCES -- Clinical Medicine -- Cancer and Oncology (hsv//eng)
- MEDICIN OCH HÄLSOVETENSKAP -- Klinisk medicin -- Kirurgi (hsv//swe)
- MEDICAL AND HEALTH SCIENCES -- Clinical Medicine -- Surgery (hsv//eng)
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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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