Short- and long-term outcomes of neoadjuvant chemotherapy in operable locally advanced colon cancer: a systematic review.
Hassan Ahmed, Adil Mohamed Ali Elnour, Ammar Aljenaid, Fatima Hassan Mahmuod, Salma Bakri Sherfeldin Mohammed, Hager Elsir Elhassan Elsafi Osman, Sami Mohammed Hamad, Saba Mukhtar, Musab
Hassan Ahmed, Adil Mohamed Ali
Elnour, Ammar
Aljenaid, Fatima
Hassan Mahmuod, Salma Bakri
Sherfeldin Mohammed, Hager Elsir
Elhassan Elsafi Osman, Sami Mohammed
Hamad, Saba
Mukhtar, Musab
Abstract
The management of operable locally advanced colon cancer has traditionally centered on upfront surgical resection. The role of neoadjuvant chemotherapy (NAC) in this setting remains a subject of investigation, with potential benefits including tumor downstaging and early treatment of micrometastases. This systematic review aims to synthesize the existing evidence on the short- and long-term outcomes of NAC for patients with operable locally advanced colon cancer. A systematic literature search was conducted across PubMed/MEDLINE, Embase, Scopus, and Web of Science up to October 2025, following Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. Studies reporting on pathological response, surgical outcomes, recurrence, disease-free survival (DFS), or overall survival (OS) in patients receiving NAC for locally advanced colon cancer were included. The risk of bias was assessed using the Cochrane RoB 2 tool for randomized trials and the ROBINS-I tool for non-randomized studies. A qualitative synthesis was performed due to heterogeneity among the included studies. Twelve studies were included. Pathological complete response rates varied, reaching up to 16% with FOLFOX-based regimens in colon cancer. NAC was associated with high R0 resection rates and acceptable postoperative morbidity. A key finding was the stage-dependent survival benefit, with a significant OS improvement specifically in T4 disease but not in T3 disease. The addition of targeted therapy based on biomarker status (e.g., panitumumab in KRAS-wildtype tumors) demonstrated significant improvements in DFS and OS. Evidence from rectal cancer studies suggested that NAC could achieve outcomes comparable to neoadjuvant chemoradiotherapy. NAC is a feasible and effective strategy for operable locally advanced colon cancer, demonstrating significant pathological responses and promising survival outcomes, particularly in T4 tumors and with biomarker-directed therapy. Its efficacy is highly dependent on careful patient selection based on disease stage and molecular characteristics. Future research should focus on randomized trials in high-risk populations and the integration of personalized treatment approaches.
MIDER Authors
Date
2025-10-24
Type
Article
Subject
Colonic Neoplasms, systematic review
Collections
Citation
Hassan Ahmed AMA, Elnour A, Aljenaid F, Hassan Mahmuod SB, Sherfeldin Mohammed HE, Elhassan Elsafi Osman SM, Hamad S, Mukhtar M. Short- and Long-Term Outcomes of Neoadjuvant Chemotherapy in Operable Locally Advanced Colon Cancer: A Systematic Review. Cureus. 2025 Oct 24;17(10):e95339. doi: 10.7759/cureus.95339
Journal / Source Title
Cureus
DOI
10.7759/cureus.95339
PMID
41287687
Publisher
Cureus Inc.