Neoadjuvant chemotherapy in locally advanced colon cancer: a systematic review
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REVIEW
Neoadjuvant chemotherapy in locally advanced colon cancer: a systematic review J. Arredondo1 · E. Pastor1 · V. Simó1 · M. Beltrán1 · C. Castañón2 · M. C. Magdaleno3 · I. Matanza4 · M. Notarnicola5 · B. Ielpo1 Received: 23 December 2019 / Accepted: 2 July 2020 © Springer Nature Switzerland AG 2020
Abstract Background Preoperative or neoadjuvant chemotherapy (NAC) has emerged as a novel alternative to treat locally advanced colon cancer (LACC), as in other gastrointestinal malignancies. However, evidence of its efficacy and safety has not yet been gathered in the literature. The aim of the present study was to perform an extensive review of the scientific evidence for NAC in patients with LACC. Methods PubMed, EMBASE, MEDLINE and Cochrane Library were searched for a systematic review of the literature from 2010 to 2019. Six eligible studies were included, with a total of 27,937 patients, 1232 of them (4.4%) treated with NAC. There were only one randomized controlled trial, three phase II non-randomized single arm studies and two retrospective studies. Results The baseline computed tomography scan showed that most of patients had a T3 tumor. The completion rate of the planned neoadjuvant treatment ranged from 52.5 to 93.8%. Between 97.2 and 100% of patients had the scheduled surgery. The median tumor volume reduction after NAC ranged from 62.5 to 63.7%. The anastomotic leak rate in the NAC group ranged from 0 to 7%, with no cases of postoperative mortality. There was major pathological tumor regression in 4–34.7% of cases. Between 84 and 100% of NAC patients had R0-surgery. Survival after NAC seems to be encouraging although significant improvement has only been proven in T4b tumours. Conclusions According to our systematic review, the NAC may be a safe and effective emerging therapeutic alternative for treating LACC. This approach, which is still being tested, increases the reliance on accurate radiological staging. Keywords Neoadjuvant therapy · Colonic neoplasms · Locally advanced colon cancer · Treatment outcome · Morbidity
Introduction Electronic supplementary material The online version of this article (https://doi.org/10.1007/s10151-020-02289-4) contains supplementary material, which is available to authorized users. * J. Arredondo [email protected] 1
Unit of Coloproctology, Service of General Surgery, University Hospital of Leon, 24071 C/ Altos de Nava s/n León, Spain
2
Service of Oncology, University Hospital of León, León, Spain
3
Service of Radiology, University Hospital of León, León, Spain
4
Service of Pathology, University Hospital of León, León, Spain
5
Service of General Surgery, Università Degli Studi Di Bari, Bari, Italy
Colon cancer (CC) is one of the most common malignancies worldwide, being the fourth most common cause of death from cancer [1]. Current national comprehensive cancer network (NCCN) Guidelines recommend chest and abdominopelvic computed tomography (CT) scan for the initial staging of CC patients [2] although other technologies, such as magn
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