Evaluating the effectiveness and safety of chemotherapy before surgery for locally advanced colon cancer.

This study investigated the safety, effectiveness, and side effect profile of chemotherapy given before surgery for the treatment of patients with locally advanced colon cancer (LACC). The data showed that this treatment was safe and effective with manageable side effects for these patients.

Colorectal cancer (CRC) is one of the most common types of cancer worldwide. CRC involves the final part of the large intestine, colon, or rectum. The first choice for the treatment of CRC is usually surgery. Often, patients are given chemotherapy after surgery to make sure any remaining cancer cells are killed. However, in more advanced stages like LACC, chemotherapy is given before surgery (neoadjuvant chemotherapy; NAC) to shrink the cancer so that it can be completely removed by surgery.

There is increasing evidence to support the use of NAC in CRC. However, its safety, effectiveness, and side effect profile for the treatment of patients with LACC is still not clear.

This study analyzed 8 studies involving a total of 1213 patients with LACC. 752 patients received NAC, followed by surgery and additional chemotherapy. NAC was usually given either with FOLFOX ( folinic acid, fluorouracil, and oxaliplatin ) or XELOX (capecitabine and oxaliplatin). In one study, NAC was given with 5-fluorouracil (5FU; Adrucil) and mitomycin (MMC; Mutamycin).

83% or more patients completed NAC treatment. In 2 studies, the NAC completion rate was 52%. The average time taken to surgery from completion of NAC ranged from 16 to 31 days.

One major complication that can occur after the surgery was anastomotic leakage. Anastomotic leakage involves the leaking of fluid from the point where the intestines are reconnected following removal of the tumor. The anastomotic leak rate in the NAC group ranged from 0 to 4.5%, with all patients surviving after surgery.

96.1% of patients in the NAC group achieved an R0 resection. This was defined as no evidence of tumor cells at the edges of the removed tissue. Patients treated with NAC were 53% more likely to have no evidence of tumor cells at the edges of the removed tissue after surgery.

Overall, 9.8% of patients in the NAC group experienced side effects. A low number of white blood cells and nerve damage were the most common NAC-related side effects.

This study concluded that NAC was safe and effective with manageable side effects for the treatment of patients with LACC.

This study analyzed the results of very different studies with different protocols. The sample size was very small in most studies. Larger studies are required to fully validate the effectiveness of NAC for the treatment of patients with LACC.