[{"data":1,"prerenderedAt":-1},["ShallowReactive",2],{"doc-seo-338968-105":3,"detail-sidebar-cat-0-en-105":81,"doc-detail-338968-en":130},{"code":4,"msg":5,"data":6},0,"ok",{"site_id":7,"language":8,"slug":9,"title":10,"keywords":11,"description":12,"schema_data":13,"social_meta":74,"head_meta":76,"extra_data":78,"updated_unix":80},105,"en","preoperative-strategies-for-locally-advanced-colon-cancer-opinion-statement-and-review","Preoperative Strategies for Locally Advanced Colon Cancer - Opinion Statement and Review","","Focuses on neoadjuvant (preoperative) systemic strategies for locally advanced colon cancer (LACC) and how treatment selection should be guided by tumor biology and staging reliability. Summarizes evidence supporting neoadjuvant chemotherapy in cT3-4 disease, while recommending avoidance in dMMR LACC due to limited pathologic response in many cases. Emphasizes early universal MMR testing, multidisciplinary patient selection, and evolving CT criteria for malignant nodes. Highlights safety and high pathologic responses with neoadjuvant immunotherapy in dMMR, potential responses in pMMR, and recommended neoadjuvant systemic therapy for cT4b disease.",{"@graph":14,"@context":73},[15,34,56],{"@type":16,"itemListElement":17},"BreadcrumbList",[18,23,27,31],{"item":19,"name":20,"@type":21,"position":22},"https://docshare.wps.com","Home","ListItem",1,{"item":24,"name":25,"@type":21,"position":26},"https://docshare.wps.com/document/","Document",2,{"item":28,"name":29,"@type":21,"position":30},"https://docshare.wps.com/document/healthcare/","Healthcare",3,{"item":32,"name":10,"@type":21,"position":33},"https://docshare.wps.com/document/preoperative-strategies-for-locally-advanced-colon-cancer-opinion-statement-and-review/338968/",4,{"url":32,"name":10,"@type":35,"image":36,"author":41,"headline":10,"publisher":44,"fileFormat":47,"inLanguage":8,"description":12,"dateModified":48,"datePublished":49,"encodingFormat":47,"isAccessibleForFree":50,"interactionStatistic":51},"DigitalDocument",{"url":37,"@type":38,"width":39,"height":40},"https://docshare.wps.com/thumbnails/preoperative-strategies-for-locally-advanced-colon-cancer-opinion-statement-and-review/338968.png","ImageObject",300,407,{"name":42,"@type":43},"Anda","Person",{"url":19,"name":45,"@type":46},"DocShare","Organization","application/pdf","2026-10-29","2026-09-21",true,{"@type":52,"interactionType":53,"userInteractionCount":55},"InteractionCounter",{"@type":54},"ViewAction",9,{"@type":57,"mainEntity":58},"FAQPage",[59,65,69],{"name":60,"@type":61,"acceptedAnswer":62},"为什么需要早期进行 MMR 状态检测来选择合适的术前治疗？","Question",{"text":63,"@type":64},"文中强调尽早开展通用的 MMR 检测对于选择合适的术前（新辅助）治疗至关重要。不同 MMR 分型对新辅助方案的获益与反应差异显著。","Answer",{"name":66,"@type":61,"acceptedAnswer":67},"cT3-4 与 dMMR 的新辅助化疗策略分别有什么关键结论？",{"text":68,"@type":64},"文中指出 FOxTROT 试验显示，对 cT3-4 LACC 的新辅助化疗可在 2 年时降低残余与复发癌风险；而对 dMMR LACC，尽可能应避免术前化疗，因为超过 50% 的 dMMR 肿瘤没有病理反应。",{"name":70,"@type":61,"acceptedAnswer":71},"cT4b LACC 的推荐新辅助系统治疗是什么？",{"text":72,"@type":64},"文中建议对所有 cT4b LACC 患者使用新辅助全身治疗。cT4b pMMR LACC 推荐使用 3 个周期 FOLFOX 化疗；若为 cT4b dMMR 且无禁忌证，则应接受新辅助免疫治疗。","https://schema.org",{"og:url":32,"og:type":75,"og:title":10,"og:site_name":45,"og:description":12},"article",{"robots":77,"canonical":32},"index,follow",{"doc_id":79,"site_id":7},338968,1790697730,{"code":4,"msg":82,"data":83},"success",[84,88,92,96,101,106,110,115,119,122,126],{"id":22,"doc_module":4,"doc_module_name":25,"category_name":85,"show_sort_weight":86,"slug":87},"Story & Novel",90,"story-novel",{"id":26,"doc_module":4,"doc_module_name":25,"category_name":89,"show_sort_weight":90,"slug":91},"Literature",80,"literature",{"id":33,"doc_module":4,"doc_module_name":25,"category_name":93,"show_sort_weight":94,"slug":95},"Exam",70,"exam",{"id":97,"doc_module":4,"doc_module_name":25,"category_name":98,"show_sort_weight":99,"slug":100},5,"Comic",60,"comic",{"id":102,"doc_module":4,"doc_module_name":25,"category_name":103,"show_sort_weight":104,"slug":105},6,"Technology",50,"technology",{"id":107,"doc_module":4,"doc_module_name":25,"category_name":29,"show_sort_weight":108,"slug":109},7,40,"healthcare",{"id":111,"doc_module":4,"doc_module_name":25,"category_name":112,"show_sort_weight":113,"slug":114},8,"Research & Report",30,"research-report",{"id":55,"doc_module":4,"doc_module_name":25,"category_name":116,"show_sort_weight":117,"slug":118},"Religion & Spirituality",20,"religion-spirituality",{"id":117,"doc_module":4,"doc_module_name":25,"category_name":120,"show_sort_weight":117,"slug":121},"World Cup","world-cup",{"id":123,"doc_module":4,"doc_module_name":25,"category_name":124,"show_sort_weight":123,"slug":125},10,"Lifestyle","lifestyle",{"id":127,"doc_module":4,"doc_module_name":25,"category_name":128,"show_sort_weight":97,"slug":129},19,"General","general",{"code":4,"msg":82,"data":131},{"doc_id":79,"user_id":132,"nickname":42,"user_avatar":133,"doc_module":4,"category_id":107,"category_name":29,"doc_title":10,"doc_description":12,"doc_content":134,"file_id":135,"file_url":136,"file_type":137,"file_size":138,"view_count":55,"is_deleted":4,"is_public":22,"is_downloadable":22,"audit_status":22,"page_count":139,"language":140,"language_code":8,"site_id":7,"html_lang":8,"table_of_contents":141,"faqs":142,"seo_title":143,"seo_description":12,"update_tm":144,"read_time":145},962075006959,"https://ap-avatar.wpscdn.com/avatar/e0002397efbe92a78e?_k=1776741047341049297","Current Treatment Options in Oncology (2024) 25:376–388 DOI 10.1007/s11864-024-01184-6  \nPreoperative Strategies for Locally Advanced Colon Cancer  \nKanika G. Nair, MD Suneel D. Kamath, MD Nivan Chowattukunnel, MD  \n*  \nSmitha S. Krishnamurthi, MD  \nAddress  \n* Department of Hematology and Oncology, Cleveland Clinic Taussig Cancer Center, 9500 Euclid Avenue, Cleveland, OH 44195, USA  \nEmail: [krishns3@ccf.org](krishns3@ccf.org)  \nPublished online: 13 February 2024  \n© The Author(s) 2024  \nKeywords Colon cancer · Neoadjuvant · Preoperative · Mismatch repair · Microsatellite instability · Microsatellite stable  \nOpinion statement  \nNeoadjuvant chemotherapy is safe for patients with locally advanced colon cancer (LACC) . The FOxTROT trial demonstrated a reduction in residual and recurrent cancer at 2 years with neoadjuvant chemotherapy for patients with cT3-4 LACC. Preoperative chemotherapy should be avoided, if possible, for patients with dMMR LACC, as over 50% of dMMR cancers have no pathologic response. Early universal testing of MMR status is critical to selecting the appropriate neoadjuvant therapy. Concerns about CT staging of LACC have limited uptake of neoadjuvant chemotherapy, as approximately 25% of patients with cT3-T4 cancer on CT have low-risk stage II disease. Development of CT criteria for malignant nodes should reduce the risk of over-staging. A multidisciplinary approach is needed to identify patients for neoadjuvant therapy. Neoadjuvant immunotherapy is safe and results in dramatic pathologic responses in patients with dMMR LACC. Longer follow-up is needed to determine if the exceptionally high pathologic response rates observed will translate into long-term remission. Remarkably, neoadjuvant immunotherapy has been found to cause major pathologic responses in a subset of patients with pMMR LACC, indicating the potential to cure more patients with this common cancer. Patients with cT4 LACC, whether stage II or III, have a substantial risk of recurrence despite adjuvant fluoropyrimidine plus oxaliplatin chemotherapy. We recommend neoadjuvant systemic therapy for all patients with cT4b LACC (dMMR and pMMR) . Features of T4b disease are routinely reported by radiology. We use three cycles of FOLFOX chemotherapy for patients with cT4b pMMR LACC, due to the high  \nrate of compliance and improvement in residual and recurrent disease. Patients with cT4bdMMR LACC should receive neoadjuvant immunotherapy, if there are no contraindications. Clinical trials of neoadjuvant therapy for LACC are of great interest and should provide training for radiologists to identify eligible patients. Results are anticipated from multiple ongoing trials of neoadjuvant chemotherapy, immunotherapy, and targeted therapy for pMMR LACC and immunotherapy for dMMR LACC.  \nIntroduction  \nPreoperative strategies for locally advanced colon cancer (LACC), defined as clinical stage II and III disease, include treatment of unresectable and resectable nonmetastatic disease. Patients with unresectable LACC should be treated with regimens that maximize the tumor response rate to enable resection while maintaining patient safety and may also include localized radiation therapy [1] . Preoperative therapy for patients with resectable disease is predominantly neoadjuvant systemic therapy, which is the focus of this review, and could be  \nchemotherapy, immunotherapy, or targeted therapies.  \nPotential advantages of neoadjuvant systemic therapy include improved disease-free survival (DFS) due to an increase in R0 resection rate and prevention of metastases through early initiation of systemic therapy. Patients with T4 and node-positive tumors have a 3-year DFS of only 60%, and those with T4N0 disease have a 5-year DFS of only 74%, despite adjuvant fluoropyrimidine and oxaliplatin chemotherapy and may benefit most from a neoadjuvant approach [2, 3] . Neoadjuvant therapy also allows an early assessment of the anti-tumor activity of systemic therapy based on pathol","cbCaick2bwC4tlVT","https://ap.wps.com/l/cbCaick2bwC4tlVT","pdf",408138,13,"English","# Opinion statement\n# Introduction\n# Neoadjuvant therapy for pMMR LACC\n# Neoadjuvant chemotherapy for pMMR LACC","[{\"question\":\"为什么需要早期进行 MMR 状态检测来选择合适的术前治疗？\",\"answer\":\"文中强调尽早开展通用的 MMR 检测对于选择合适的术前（新辅助）治疗至关重要。不同 MMR 分型对新辅助方案的获益与反应差异显著。\"},{\"question\":\"cT3-4 与 dMMR 的新辅助化疗策略分别有什么关键结论？\",\"answer\":\"文中指出 FOxTROT 试验显示，对 cT3-4 LACC 的新辅助化疗可在 2 年时降低残余与复发癌风险；而对 dMMR LACC，尽可能应避免术前化疗，因为超过 50% 的 dMMR 肿瘤没有病理反应。\"},{\"question\":\"cT4b LACC 的推荐新辅助系统治疗是什么？\",\"answer\":\"文中建议对所有 cT4b LACC 患者使用新辅助全身治疗。cT4b pMMR LACC 推荐使用 3 个周期 FOLFOX 化疗；若为 cT4b dMMR 且无禁忌证，则应接受新辅助免疫治疗。\"}]","Preoperative Strategies for Locally Advanced Colon Cancer - Opinion Statement and Review | PDF",1790026872,33]