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Neoadjuvant chemotherapy improves 2 year survival in operable colon cancer

14th February 2023

Neoadjuvant chemotherapy provided 6 weeks prior to colon cancer surgery reduces residual or recurrent disease within the following 2 years

The provision of neoadjuvant chemotherapy (NAC) for patients with operable colon cancer lead to histopathologic down-staging and better 2-year disease control according to the findings of study by Swedish and UK researchers.

Colorectal cancer is the 3rd most common cancer globally with 1.9 million new cases in 2020 and 935,173 deaths. The use of neoadjuvant chemotherapy has been shown to be of value at reducing tumour size and stage in patients with other operable cancers such as gastric and lower oesophageal adenocarcinomas but this approach has not been explored in the treatment of patients with colon cancer, possibly due to risk that treatment toxicities may compromise patient’s fitness for subsequent surgery.

However, despite the potential concerns, in the current study, researchers randomised patients 2:1 with radiologically staged T3-4, NO-2, MO colon cancer to either 6 weeks of preoperative oxaliplatin-fluoropyrimidine therapy followed by 18 weeks of postoperative adjuvant therapy (the intervention group) or postoperative chemotherapy only and which served as the control arm. They set the primary outcome as residual or recurrent disease within 2 years of randomisation, defined as no resection or macroscopic incomplete resection, that is, residual tumour or metastases following surgery. For the secondary outcomes, the team looked at several measures including surgical morbidity, histopathologic stage and cause-specific mortality.

Neoadjuvant chemotherapy and cancer surgery outcomes\

A total of 686 patients assigned to NAC and 351 control patients were included in the analysis.

The primary outcome occurred significantly less frequently in those assigned to NAC (rate ratio, RR = 0.72, 95% CI 0.54 – 0.98, p = 0.037). Moreover, there was also a reduction, albeit non-significant, in colon-cancer specific mortality (RR = 0.74, 95% CI 0.52 – 1.05, p = 0.095).

In addition, the researchers observed substantial reductions in T stage (21% vs 31%, NAC vs control, p < 0.001) and a higher proportion of NAC patients had histopathologically complete resections (94% vs 89%, p < 0.001).

Based on these findings, the authors concluded that NAC should be considered as a treatment option for patients with locally advanced colon cancer.

Citation
Morton D et al. Preoperative Chemotherapy for Operable Colon Cancer: Mature Results of an International Randomized Controlled Trial. J Clin Oncol 2023

Neoadjuvant chemotherapy improves 2 year survival in operable colon cancer

Cone beam breast CT superior to MRI for detection of preoperative residual tumour

20th January 2023

The use of contrast-enhanced cone beam breast computed tomography was superior to MRI in the assessment of residual preoperative tumour

Using contrast-enhanced cone beam breast CT provides a more accurate assessment of residual tumour following neoadjuvant chemotherapy compared to magnetic resonance imaging (MRI) according to the findings of a comparative study by Chinese researchers.

Neoadjuvant chemotherapy is used prior to breast cancer surgery in patients with locally advanced breast cancer to reduce the size of the tumour. An assessment of the size of unresectable residual tumour is required since this is an important factor in the local recurrence of disease following breast conserving therapy. Radiological examination has an important role in the assessment of residual tumour and MRI has been shown to be more accurate that other imaging modalities for an evaluation of the response to treatment. Cone beam breast CT is a relatively novel technique that has shown promise for the early diagnosis of malignant breast cancer and can also differentiate between malignant and benign breast tissue.

However, to date, no studies have examined the accuracy of cone beam breast CT for the assessment of residual tumour following neoadjuvant chemotherapy. In the current study, the Chinese team compared cone beam breast CT and MRI for the assessment of tumour size following neoadjuvant chemotherapy and retrospectively compared the results of the two methods with those obtained with the findings from pathology. In addition, the researchers examined the predictive value of the two approaches for a pathological complete response. The level of agreement between the tumour size based on the two methods was compared to the findings on pathology and assessed using the intraclass correlation coefficient (ICC).

Cone beam breast CT and assessment of residual tumour

Data were available for 91 women with a median age of 45 years, the majority (73.6%) of whom were premenopausal.

When compared with pathology, there was good agreement for the cone beam breast CT (ICC = 0.64, 95% CI 0.35 – 0.78). In contrast, comparison with MRI was only moderate (ICC= 0.59, 95% CI 0.36 – 0.77). In subgroup analysis, the cone beam was also superior to MRI for residual ductal carcinoma in situ (p < 0.001).

For predictive purposes, the area under the receiver operating characteristics curve for predicting a pathological complete response were similar for both imaging modalities (AUC = 0.749 for cone beam and 0.733 for MRI, p > 0.05).

The authors concluded that cone beam breast CT was superior to MRI for an assessment of residual tumour following neoadjuvant chemotherapy and could therefore be seen as an alternative means of assessment.

Citation
Wang Y et al. Accuracy of Preoperative Contrast-enhanced Cone Beam Breast CT in Assessment of Residual Tumor after Neoadjuvant Chemotherapy: A Comparative Study with Breast MRI. Acad Radiol 2023