Short-course preoperative radiotherapy with immediate surgery versus long-course chemoradiation with delayed surgery in the treatment of rectal cancer: A systematic review and meta-analysis |
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| Affiliation: | 1. Department of Radiation Oncology, Fudan University Shanghai Cancer Center, Shanghai 200032, PR China;2. Department of Oncology, Shanghai Medical College, Fudan University, Shanghai 200032, PR China;3. Department of Radiation Oncology, Tumor Hospital of Jilin Province, No. 1018, Huguang Road, 130012 Changchun, PR China;4. Internal Medicine of Traditional Chinese Medicine Department, Jing''an District Central Hospital of Shanghai, No. 259, Xikang Road, 200040 Shanghai, PR China;5. Department of Orthopaedics, Tianjin Medical University General Hospital, 154 Anshan Road, Heping District, Tianjin, PR China;6. Systematic Review Solutions Ltd, Nottingham NG72TU, UK;7. Department of Laboratory Medicine, General Hospital of Ji''nan Military Command Region, 250031 Ji''nan, PR China;8. Department of Digestive System, Xiyuan Hospital, China Academy of Traditional Chinese Medicine, Xiyuan No.1, 100091 Beijing, PR China;1. CAS Key Laboratory of Materials for Energy Conversion, Shanghai Institute of Ceramics, Chinese Academy of Sciences, Shanghai 200050, PR China;2. National Laboratory of Molecular Science and State Key Laboratory of Rare Earth Materials Chemistry and Applications, College of Chemistry and Molecular Engineering, Peking University, Beijing 100871, PR China;1. Department of Radiation Oncology, University of Wuerzburg, Germany;2. Department of Surgery I, University of Wuerzburg, Germany;1. Medical Physics, San Raffaele Scientific Institute, Milano, Italy;2. Istituto di Bioimmagini e Fisiologia Molecolare, CNR, Segrate, Milano, Italy;3. Radiotherapy, San Raffaele Scientific Institute, Milano, Italy;4. Medical Physics, San Martino–IST Scientific Institute, Genova, Italy;1. Department of Surgery, Radboud University Medical Center, Nijmegen, The Netherlands;2. Netherlands Comprehensive Cancer Organisation, Utrecht, The Netherlands;3. Department of Radiation Oncology, Radboud University Medical Center, Nijmegen, The Netherlands;4. Department of Radiation Oncology, Institut Curie, Paris, France;5. Department of Pathology, Radboud University Medical Center, Nijmegen, The Netherlands;1. Institute of Cancer Sciences, Manchester Academic Health Science Centre, University of Manchester, Manchester, UK;2. Centre for Biostatistics, Institute of Population Health, University of Manchester, Manchester, UK;3. Department of Colorectal Surgery, The Christie NHS Foundation Trust, Manchester, UK;4. Department of Clinical Oncology, The Christie NHS Foundation Trust, Manchester, UK;5. North Wales Cancer Treatment Centre, Rhyl, UK;6. Clatterbridge Cancer Centre, Liverpool, UK;7. Royal Liverpool Hospital NHS Foundation Trust, Liverpool, UK;8. Royal Preston NHS Foundation Trust, Preston, UK;1. Department of Radiation Oncology, University Medical Center, Utrecht, The Netherlands;2. Department of Radiology, University Medical Center, Utrecht, The Netherlands;3. Trial Bureau Imaging Division, University Medical Center, Utrecht, The Netherlands |
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| Abstract: | BackgroundLong-course chemoradiotherapy (LCRT) with delayed surgery or short-course radiotherapy (SCRT) with immediate surgery is probably the most frequent regimen in the treatment of rectal cancer. Debate is still going on whether SCRT or LCRT is more effective. So we performed this meta-analysis to evaluate the safety and efficacy of SCRT with immediate surgery versus LCRT with delayed surgery for the management of rectal cancer.MethodsLiterature were searched from PubMed, Embase, Web of science, Cochrane Library up to May, 2014. Quality of the randomized controlled trials (RCTs) was evaluated according to the Cochrane's risk of bias tool of RCT. RevMan 5.3 was used for statistical analysis. Pooled risk ratio (RR) and 95% confidence interval (CI) were calculated. Subgroup analysis and sensitivity analysis were employed to explore heterogeneity.Results16 trials were included in the qualitative systematic review. 12 trials were included in meta-analyses. 4 of them were RCTs; other 8 were non-RCTs. Meta-analysis demonstrated that there were no significant differences in overall survival (OS), disease free survival (DFS), local recurrence rate (LRR), distant metastasis rate (DMR), sphincter preservation rate, R0 resection rate and late toxicity. Compared with SCRT, LCRT obviously increased pCR rate [RR = 0.15, 95%CI (0.08, 0.28), P = 0.003], while LCRT obviously increased the grade 3–4 acute toxicity [RR = 0.13, 95%CI (0.06, 0.28), P < 0.00001].ConclusionsSCRT with immediate surgery is as effective as LCRT with delayed surgery for treatment of rectal cancer in terms of OS, DFS, LRR, DMR, Sphincter preservation rate, R0 resection rate and late toxicity. Though LCRT increased pCR rate, LCRT also increased acute toxicity compared with SCRT. SCRT is a better choice in centers with a long waiting list or lack of medical resources. |
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| Keywords: | Rectal cancer Preoperative radiotherapy Chemoradiotherapy Meta-analysis |
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