Immediate results of neoadjuvant chemotherapy for resectable colon cancer

The aim of this study was the development, clinical evaluation, assessment of tolerability, and immediate efficacy of combined treatment for patients with resectable colon cancer using total neoadjuvant chemotherapy (NACT) based on the FolFox-6 regimen. Material and methods. The study included 30 patients with morphologically verified operable colon cancer at stages cT3–4N0–2. The treatment protocol consisted of 8 courses of preoperative chemotherapy according to the FolFox-6 regimen: oxaliplatin 85 mg/m² administered as a 2-hour intravenous infusion on day 1; calcium folinate 400 mg/m² administered intravenously over 2 hours, followed by a bolus of 5-fluorouracil 400 mg/m² intravenously, and a continuous 46-hour infusion of 5-fluorouracil 2400 mg/m² (1200 mg/m²/day). The interval between chemotherapy courses was 2 weeks. After evaluating the effectiveness of the therapy, radical surgery with D2 lymphadenectomy was performed. The period from the end of chemotherapy to the surgical stage of combined treatment was 6–8 weeks. Results. Of the 30 patients enrolled, 29 (96.7 %) completed the planned chemotherapy regimen, while 1 patient (3.3 %) received only 4 cycles due to grade III polyneuropathy, resulting in treatment discontinuation. The overall toxicity profile of neoadjuvant chemotherapy was 73%. The most common adverse events were hematological toxicities (53.3 %) and dyspeptic syndrome (26.7 %). Preoperative assessment revealed complete regression in 3 patients (10.3 %), partial regression in 15 (51.7 %), disease stabilization in 9 (31.0 %), and progression in 2 (6.9 %). All patients underwent radical surgery (R0). In most cases (n=25, 83.3 %), laparoscopic procedures were performed. Postoperative complications of grade IIIa according to the Clavien–Dindo classification occurred in 3 cases (10.0 %): re-laparotomy was required for one patient (3.3 %) due to anastomotic leakage and for two patients (6.7 %) due to intestinal obstruction. Histopathological analysis of surgical specimens revealed the following tumor regression grades (TRG): TRG 1 – 6.9 %, TRG 2 – 17.2 %, TRG 3 – 17.2 %, TRG 4 – 48.2 %, and TRG 5 – 10.3 %. Tumor downstaging was observed in 10 patients (34.5 %). Conclusion. The obtained results indicate the high immediate efficacy and satisfactory tolerability of total neoadjuvant chemotherapy using the FolFox-6 regimen in the combined treatment of resectable colon cancer.

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