Effectiveness of neoadjuvant concurrent chemoradiotherapy versus up-front proctectomy in clinical stage II-III rectal cancer: A population-based study

Liao, Yu Min; Chiang, Hua Che; Chang, Sheng Chi; Wang, Pin Hui; Chen, Yi Ya; Chen, William Tzu Liang; Chien, Chun Ru

doi:10.1111/ajco.12172

Cited by 9 publications

(6 citation statements)

References 18 publications

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“…[9] Compared with upfront surgery, the possible advantages of neoadjuvant CRT in the treatment of LARC include gained resectability and an increased rate of sphincter preservation. [7,10] According to the results of the German CAO/ARO/AIO-94 randomized phase III trial, preoperative CRT showed improved pelvic control and sphincter preservation and less acute/chronic toxicity than postoperative chemoradiotherapy, [7] and there is a persisting significant improvement of pre versus postoperative CRT on local control. [7,8] There is also evidence that showed that preoperative CRT reduce overall long-term surgical complications compared with postoperative CRT.…”

Section: Introductionmentioning

confidence: 99%

Capecitabine versus 5-fluorouracil in neoadjuvant chemoradiotherapy of locally advanced rectal cancer

et al. 2019

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Background:The differences in efficacy between capecitabine and 5-fuorouracil (5-FU) in neoadjuvant chemoradiotherapy (CRT) of locally advanced rectal cancer (LARC) are not well recognized. We performed this meta-analysis to analyze the effect of capecitabine and 5-FU on neoadjuvant CRT to more accurately understand the differences between the 2 drugs.Methods:MEDLINE, EMBASE, Cochrane Library, China National Knowledge Infrastructure, and Wanfang Database were performed to identify all published studies investigating the efficacy of capecitabine in neoadjuvant CRT of LARC versus 5-FU before August, 2017. Primary endpoint was the odds ratio (OR) for improving pathological complete response (pCR) rate of patients with LARC. Secondary endpoints were the ORs of efficiency for downstaging tumor and increasing R0 resection in patients with LARC. Safety analyses were also performed. The OR was the principal measurement of effect, which was calculated as capecitabine group versus 5-FU group, and was presented as a point estimate with 95% confidence intervals (CIs). All calculations and statistical tests were performed using RevMan 5.3 software.Results:In all, 2916 patients with LARC enrolled in the 10 studies were divided into capecitabine group (n = 1451) and 5-FU group (n = 1465). The meta-analysis showed that capecitabine improved pCR (OR 1.34, 95% CI 1.10–1.63), and R0 resection rate (OR 1.92, 95% CI 1.10–3.36). There were no statistically significant differences either in overall downstaging rate (OR 1.31, 95% CI 0.79–2.16) or in the tumor downstaging rate (OR 1.24, 95% CI 0.79–1.92), but there was a significant difference of the nodal downstaging rate between the 2 groups (OR 1.68, 95% CI 1.11–2.54). There was no statistically significant difference in sphincter preservation rate between the 2 groups (OR 1.36, 95% CI 0.96–1.92). No obvious safety concerns about mortality and complications were raised in these studies. There were no statistically significant differences in 3-year disease-free-survival (OR 1.29, 95% CI 0.75–2.20), and in grade 3 to 4 acute toxicity during CRT (OR 0.63, 95% CI 0.31–1.30).Conclusions:Compared with 5-FU-based neoadjuvant CRT, capecitabine-based neoadjuvant CRT can safely improve pCR, nodal down-staging, ad R0 resection of patients with LARC.

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Section: Introductionmentioning

confidence: 99%

Capecitabine versus 5-fluorouracil in neoadjuvant chemoradiotherapy of locally advanced rectal cancer

et al. 2019

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“…We then used the logit of the probability as the PS, as is typically used in the literature (14). We defined the co-variables based on our prior clinical-and HWDC-related research experiences (15)(16)(17). We Statistical and supplementary analysis.…”

Section: Methodsmentioning

confidence: 99%

A Comparative Effectiveness Study of Two Oral Chemotherapy Drugs (UFT vs. Capecitabine) in Neoadjuvant Concurrent Chemoradiotherapy for Patients with Locally Advanced Rectal Cancer

Chien¹,

Chen²,

Wang³

et al. 2016

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“…Secondly, we collected additional factors that might affect both the use and cost of NCCRT for locally advanced esophageal cancer patients based on our clinical and research experiences. In this regard, we also included patient demographic factors (age, gender, and residency), patient characteristics (comorbidity, SES), disease (stage), and health service provider characteristics (treating hospital level and surgeon's experience) based on our clinical experiences and prior NHI Research Database (NHIRD) and HWDC related studies . Patient residency was classified as northern Taiwan or non‐north; hospital was classified as medical centers or regional hospitals.…”

Section: Methodsmentioning

confidence: 99%

Cost‐effectiveness of neoadjuvant concurrent chemoradiotherapy versus esophagectomy for locally advanced esophageal squamous cell carcinoma: A population‐based matched case‐control study

et al. 2015

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BackgroundNeoadjuvant concurrent chemoradiotherapy (NCCRT) is often considered for locally‐advanced esophageal squamous cell carcinoma (LA‐ESCC) patients; however, no data regarding the cost‐effectiveness of this treatment is available. Our study aimed to evaluate the cost‐effectiveness of NCCRT versus esophagectomy for LA‐ESCC at population level.MethodsWe identified LA‐ESCC patients diagnosed within 2008–2009 and treated with either NCCRT or esophagectomy through the Taiwan Cancer Registry. We included potential confounding covariables (age, gender, residency, comorbidity, social‐economic status, disease stage, treating hospital level and surgeon's experience, and the use of endoscopic ultrasound before treatment) and used propensity score (PS) to construct a 1:1 population. The duration of interest was three years within the date of diagnosis. Effectiveness was measured as overall survival. We took the payer's perspective and converted the cost to 2014 United States dollars (USD). In sensitivity analysis, we evaluated the potential impact of an unmeasured confounder on the statistical significance of incremental net benefit at suggested willingness‐to‐pay.ResultsOur study population constituted 150 PS matched subjects. The mean cost (2014 USD) and survival (year) were higher for NCCRT compared with esophagectomy (US$91,460 vs. $75,836 for cost; 2.2 vs. 1.8 for survival) with an estimated incremental cost‐effectiveness ratio of US$39,060/life‐year.ConclusionsWhen compared to esophagectomy, NCCRT is likely to improve survival and is probably more cost‐effective. Cost‐effectiveness results should be interpreted with caution given our results were sensitive to potential unmeasured confounder(s) in sensitivity analysis.

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Effectiveness of neoadjuvant concurrent chemoradiotherapy versus up-front proctectomy in clinical stage II-III rectal cancer: A population-based study

Cited by 9 publications

References 18 publications

Capecitabine versus 5-fluorouracil in neoadjuvant chemoradiotherapy of locally advanced rectal cancer

Capecitabine versus 5-fluorouracil in neoadjuvant chemoradiotherapy of locally advanced rectal cancer

A Comparative Effectiveness Study of Two Oral Chemotherapy Drugs (UFT vs. Capecitabine) in Neoadjuvant Concurrent Chemoradiotherapy for Patients with Locally Advanced Rectal Cancer

Cost‐effectiveness of neoadjuvant concurrent chemoradiotherapy versus esophagectomy for locally advanced esophageal squamous cell carcinoma: A population‐based matched case‐control study

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