This protocol applies to patients with proficient mismatch repair (pMMR) / microsatellite stable (MSS) colon adenocarcinoma that is non-metastatic but cannot be surgically removed at presentation — either because the tumour is locally unresectable or because the patient is medically inoperable.
The tumour is confirmed pMMR/MSS and non-metastatic. It is not amenable to upfront resection due to local extent or the patient's operative status. The central clinical question is whether the disease can be converted to a resectable state.
Systemic therapy forms the backbone of management. Radiation therapy (RT), combined with a fluoropyrimidine-based chemotherapy agent, may be considered prior to surgery with the aim of converting unresectable disease to a resectable state. The complete sequence, regimen selection, and all further details are available in the full protocol.