Preoperative short-course radiotherapy followed by consolidation chemotherapy for treatment with locally advanced rectal cancer: a meta-analysis

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Abstract

Background

The addition of consolidation chemotherapy to preoperative short-course radiotherapy during the prolonged interval between the completion of radiation and surgery in locally advanced rectal cancer (LARC) could enhance pathologic response and might act on potential micrometastasis. We performed this meta-analysis to evaluate whether short-course radiotherapy followed by consolidation chemotherapy (SCRT/CCT) could be a neoadjuvant treatment option compared with conventional long-course chemoradiotherapy (LCCRT).

Methods

We searched the PubMed, EMBASE, MEDLINE, and Cochrane Library databases. The primary endpoints were pathological outcomes, and the secondary endpoints included survival rate, sphincter preservation rate, R0 resection rate and toxicity. RevMan 5.3 was used to calculate pooled risk ratio (RRs) and 95% confidence intervals (CIs).

Results

A total of seven eligible studies and 1865 participants were included in this meta-analysis. Compared with the LCCRT, SCRT/CCT increased pathologic complete response (pCR) rate [RR = 1.74, 95% CI (1.41, 2.15), P < 0.01] and led to a lower proportion of patients with adjuvant pathologic tumor stage 3–4 (ypT3-4) disease [RR = 0.88, 95% CI (0.80, 0.97), P = 0.01] or lymph node positive (ypN +) disease [RR = 0.83, 95% CI (0.71, 0.98), P = 0.02]. In addition, the disease-free survival (DFS) was better in SCRT/CCT group [RR = 1.10, 95% CI (1.02, 1.18), P = 0.01], while overall survival rate and toxicity and surgical procedures were similar between two groups.

Conclusion

Based on better pathological outcomes and DFS in SCRT/CCT group, we recommended preoperative short-course radiotherapy followed by consolidation chemotherapy as the optional neoadjuvant treatment for LARC.

Supplementary Information

The online version contains supplementary material available at 10.1186/s13014-021-01974-4.

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Most cited references 39

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Short-course radiotherapy followed by chemotherapy before total mesorectal excision (TME) versus preoperative chemoradiotherapy, TME, and optional adjuvant chemotherapy in locally advanced rectal cancer (RAPIDO): a randomised, open-label, phase 3 trial

Renu Bahadoer, Esmée A Dijkstra, Boudewijn van Etten … (2020)

Systemic relapses remain a major problem in locally advanced rectal cancer. Using short-course radiotherapy followed by chemotherapy and delayed surgery, the Rectal cancer And Preoperative Induction therapy followed by Dedicated Operation (RAPIDO) trial aimed to reduce distant metastases without compromising locoregional control.

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Long-term outcome in patients with a pathological complete response after chemoradiation for rectal cancer: a pooled analysis of individual patient data.

Julio García-Cordero, Mohammed Mohiuddin, Claus Rödel … (2010)

Locally advanced rectal cancer is usually treated with preoperative chemoradiation. After chemoradiation and surgery, 15-27% of the patients have no residual viable tumour at pathological examination, a pathological complete response (pCR). This study established whether patients with pCR have better long-term outcome than do those without pCR. In PubMed, Medline, and Embase we identified 27 articles, based on 17 different datasets, for long-term outcome of patients with and without pCR. 14 investigators agreed to provide individual patient data. All patients underwent chemoradiation and total mesorectal excision. Primary outcome was 5-year disease-free survival. Kaplan-Meier survival functions were computed and hazard ratios (HRs) calculated, with the Cox proportional hazards model. Subgroup analyses were done to test for effect modification by other predicting factors. Interstudy heterogeneity was assessed for disease-free survival and overall survival with forest plots and the Q test. 484 of 3105 included patients had a pCR. Median follow-up for all patients was 48 months (range 0-277). 5-year crude disease-free survival was 83.3% (95% CI 78.8-87.0) for patients with pCR (61/419 patients had disease recurrence) and 65.6% (63.6-68.0) for those without pCR (747/2263; HR 0.44, 95% CI 0.34-0.57; p<0.0001). The Q test and forest plots did not suggest significant interstudy variation. The adjusted HR for pCR for failure was 0.54 (95% CI 0.40-0.73), indicating that patients with pCR had a significantly increased probability of disease-free survival. The adjusted HR for disease-free survival for administration of adjuvant chemotherapy was 0.91 (95% CI 0.73-1.12). The effect of pCR on disease-free survival was not modified by other prognostic factors. Patients with pCR after chemoradiation have better long-term outcome than do those without pCR. pCR might be indicative of a prognostically favourable biological tumour profile with less propensity for local or distant recurrence and improved survival. None. Copyright 2010 Elsevier Ltd. All rights reserved.

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Author and article information

Contributors

Zongguang Zhou:

ORCID: http://orcid.org/0000-0002-7616-1199

zhou767@163.com

Journal

Journal ID (nlm-ta): Radiat Oncol

Journal ID (iso-abbrev): Radiat Oncol

Title: Radiation Oncology (London, England)

Publisher: BioMed Central (London )

ISSN (Electronic): 1748-717X

Publication date (Electronic): 24 January 2022

Publication date PMC-release: 24 January 2022

Publication date Collection: 2022

Volume: 17

Electronic Location Identifier: 14

Affiliations

[1 ]GRID grid.13291.38, ISNI 0000 0001 0807 1581, Laboratory of Digestive Surgery, State Key Laboratory of Biotherapy and Cancer Center, , Sichuan University, ; Chengdu, 610041 China

[2 ]GRID grid.13291.38, ISNI 0000 0001 0807 1581, Department of Gastrointestinal Surgery, West China Hospital, West China School of Medicine, , Sichuan University, ; No. 37, Guo Xue Xiang, Chengdu, 610041 China

[3 ]GRID grid.13291.38, ISNI 0000 0001 0807 1581, Department of Pediatric Surgery, West China Hospital, West China School of Medicine, , Sichuan University, ; Chengdu, 610041 China

[4 ]GRID grid.13291.38, ISNI 0000 0001 0807 1581, Department of Gastrointestinal Surgery and Breast and Thyroid Surgery, Minimally Invasive Surgery, West China School of Public Health, , Sichuan University, ; Chengdu, 610041 China

[5 ]GRID grid.13291.38, ISNI 0000 0001 0807 1581, West China Fourth Hospital, , Sichuan University, ; Chengdu, 610041 China

[6 ]GRID grid.5640.7, ISNI 0000 0001 2162 9922, Department of Oncology, , Linköping University, ; 58183 Linköping, Sweden

[7 ]GRID grid.5640.7, ISNI 0000 0001 2162 9922, Department of Biomedical and Clinical Sciences, , Linköping University, ; 58183 Linköping, Sweden

Author information

Zongguang Zhou http://orcid.org/0000-0002-7616-1199

Article

Publisher ID: 1974

DOI: 10.1186/s13014-021-01974-4

PMC ID: 8785003

PubMed ID: 35073940

SO-VID: 74c79663-4083-46ed-9844-2cf93572543a

License:

Open AccessThis article is licensed under a Creative Commons Attribution 4.0 International License, which permits use, sharing, adaptation, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons licence, and indicate if changes were made. The images or other third party material in this article are included in the article's Creative Commons licence, unless indicated otherwise in a credit line to the material. If material is not included in the article's Creative Commons licence and your intended use is not permitted by statutory regulation or exceeds the permitted use, you will need to obtain permission directly from the copyright holder. To view a copy of this licence, visit http://creativecommons.org/licenses/by/4.0/. The Creative Commons Public Domain Dedication waiver ( http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated in a credit line to the data.

History

Date received : 1 September 2021

Date accepted : 21 December 2021

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ScienceOpen disciplines: Oncology & Radiotherapy

Keywords: rectal cancer,short-course radiotherapy,consolidation chemotherapy,meta-analysis

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ScienceOpen disciplines: Oncology & Radiotherapy

Keywords: rectal cancer, short-course radiotherapy, consolidation chemotherapy, meta-analysis

Preoperative short-course radiotherapy followed by consolidation chemotherapy for treatment with locally advanced rectal cancer: a meta-analysis

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Karger: Oncology

Most cited references 39

Critical evaluation of the Newcastle-Ottawa scale for the assessment of the quality of nonrandomized studies in meta-analyses.

Short-course radiotherapy followed by chemotherapy before total mesorectal excision (TME) versus preoperative chemoradiotherapy, TME, and optional adjuvant chemotherapy in locally advanced rectal cancer (RAPIDO): a randomised, open-label, phase 3 trial

Long-term outcome in patients with a pathological complete response after chemoradiation for rectal cancer: a pooled analysis of individual patient data.

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