“Preoperative (neoadjuvant) chemotherapy and radiotherapy are substantially more effective than similar postoperative therapy in oesophageal, gastric, and rectal cancer. Earlier treatment might be more effective at eradicating micrometastatic disease than the same treatment 3 months later, the typical period between diagnosis and starting postoperative chemotherapy, particularly because surgery increases growth factor activity in the early postoperative period, promoting more rapid tumour progression.”

“In summary, we have shown that patients with locally advanced, but resectable, colon cancer can be appropriately selected for neoadjuvant chemotherapy with CT scanning, can be molecularly stratified preoperatively, and can safely undergo preoperative chemotherapy followed by colonic resectional surgery, without incurring significant perioperative morbidity. We have also shown significant downstaging of primary tumours, including fewer incomplete resections and reduced apical lymph node metastases, after only 6 weeks of combination therapy.”

Foxtrot Collaborative Group (2012). Feasibility of preoperative chemotherapy for locally advanced, operable colon cancer: the pilot phase of a randomised controlled trial. The Lancet. Oncology, 13(11), 1152–1160.