Preoperative chemoradiation <i>vs</i> radiation alone for stage II and III resectable rectal cancer: a meta‐analysis

Latkauskas, Tadas; Paškauskas, Saulius; Dambrauskas, Žilvinas; Gudaitytė, Jūratė; Saladzinskas, S; Tamelis, Algimantas; Pavalkis, Dainius

doi:10.1111/j.1463-1318.2009.02015.x

Cited by 19 publications

(11 citation statements)

References 38 publications

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“…Two meta-analyses revealed no differences between these regimens in terms of the rates of survival, local recurrence, morbidity, mortality, resectability and the rate of sphincter preservation, and only pathological complete response and toxicity were higher after neoadjuvant chemotherapy [8, 9]. Bujko et al compared neoadjuvant short-course radiotherapy (RT) followed by surgery within 7 days with conventional long-course chemoradiotherapy (CRT) and found that 4 years overall, disease-free survival rates and local recurrence rate did not differ significantly between the groups [6].…”

Section: Discussionmentioning

confidence: 99%

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Preoperative conventional chemoradiotherapy versus short-course radiotherapy with delayed surgery for rectal cancer: results of a randomized controlled trial

et al. 2016

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Background: There still is no evidence which neoadjuvant therapy regimen for stage II-III rectal cancer is superior. The aim of this study was to compare results achieved after long-course chemoradiotherapy (CRT) with short-term radiotherapy (RT) followed by delayed surgery. Methods: A randomized trial was carried out between 2007-2013. One hundred fifty patients diagnosed with stage II-III rectal cancer were randomized into one of two neoadjuvant treatment arms: conventional chemoradiotherapy (CRT) and short-term radiotherapy (RT) followed by surgery after 6-8 weeks. Primary endpoints of this trial were downstaging and pathological complete response rate. Secondary endpoints were local recurrence rate and overall survival. Results: The pathological complete response was found in 3 (4.4%) cases after RT and 8 (11.1%) after CRT (P = 0. 112). Downstaging (stage 0 and I) was observed in 21 (30.9%) cases in RT group vs. 27 (37.5%) cases in CRT group (P = 0.409). Median follow-up time was 39.7 (range 4.9-79.7) months. 3-years overall survival (OS) was 78% in RT group vs. 82.4% in CRT group (P = 0.145), while disease-free survival (DFS) differed significantly -59% in RT group vs. 75.1% in CRT group (P = 0,022). Hazard ratio of cancer progression for RT patients was 1.93 (95% CI: 1.08-3.43) compared to CRT patients. Conclusion: Three-years disease-free survival was better in CRT group comparing with RT group with no difference in overall survival.

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Section: Discussionmentioning

confidence: 99%

“…Two meta-analysis [8, 9] and review [10] showed no differences between these regimens in terms of survival, local recurrence, morbidity, mortality, resectability and the rate of sphincter preservation; however, pathological complete response and toxicity were higher after neoadjuvant chemoradiation.…”

Section: Introductionmentioning

confidence: 99%

Preoperative conventional chemoradiotherapy versus short-course radiotherapy with delayed surgery for rectal cancer: results of a randomized controlled trial

et al. 2016

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“…Accumulating evidence reveals the clinical impacts of these therapies for surgical and oncological outcomes in patients with advanced rectal cancer. The pathological response in surgical specimens for preoperative RT was superior in long-course RT compared with short-course RT; however, previous studies revealed no difference between these two therapies in terms of survival and local recurrence [2,6,7].…”

Section: Identification Of Predictors Of Recurrence Inmentioning

confidence: 60%

“…Accumulating evidence reveals that both regimens could inhibit local recurrence and improve survival, and the effects of both regimens are currently considered to be comparable [2,6,7,25,26]. To further improve prognosis, we need to elucidate the clinicopathological factors in each treatment course to discriminate candidates who might benefit from more intensive adjuvant therapy after curative surgery.…”

Section: Discussionmentioning

confidence: 99%

Identification of Predictors of Recurrence in Patients with Lower Rectal Cancer Undergoing Neoadjuvant Chemotherapy: A Direct Comparison of Short-Course and Long-Course Chemoradiotherapy

et al. 2018

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Objective: This study aimed to investigate clinicopathological responses and oncological outcome in patients receiving short- or long-course chemoradiotherapy (CRT) and to assess the predictive factor for recurrence in each treatment. Methods: A total of 118 rectal cancer patients receiving preoperative CRT were enrolled. Clinicopathological responses and oncological outcome in patients receiving short- or long-course CRT were investigated. Results: Despite there being no significant differences in the prognosis of disease-free survival (DFS) based on TNM stage classification in patients receiving long-course CRT, patients with advanced stage demonstrated poor DFS after short-course CRT. The presence of lymph node metastasis was a predictor of poor DFS in short-course CRT, whereas poor pathological response was a predictor of recurrence in long-course CRT. Conclusions: Distinct predictors of recurrence depending on the CRT course might be needed to discriminate candidates from rectal cancer patients receiving preoperative CRT who might benefit from more intensive adjuvant therapy after surgery.

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“…12 weeks after the start of treatment. 36,37 Another small randomised study 38 also investigated the impact of the interval between SCPRT and surgery on OS, and recurrence rate (see Table 1). Counterintuitively, a lower rate of systemic recurrence was observed in patients operated on with the longer interval of 4 to 5 weeks after SCPRT (2.8 % versus 12.3 %) than in patients with the shorter interval of 7 to 10 days (p=0.035).…”

Section: 24mentioning

confidence: 99%

How to Select for Preoperative Short-course Radiotherapy, While Considering Long-course Chemoradiotherapy or Immediate Surgery, and Who Benefits?

Glynne-Jones¹,

Dt²,

Moran³

et al. 2014

European Oncology &Amp; Haematology

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The management of patients with locally advanced rectal cancer (LARC) has evolved with the aim of reducing local recurrence and improving survival. Current practice has developed from refinements in surgical technique, the availability of different types of preoperative imaging, the selective or blanket use of neoadjuvant treatment (usually radiation) and sophisticated efforts exploring multimodality treatments to achieve organ preservation. Both short-course preoperative radiotherapy (SCPRT) and long-course chemoradiation (CRT) are considered standard neoadjuvant strategies, which are advocated in different parts of the world. New techniques in the delivery of radiotherapy, such as intensity-modulated radiotherapy (IMRT), may allow more precise dosing to the target volume (tumour and/or locoregional lymph nodes) and limit radiation doses to critical normal structures; however, current schedules of SCPRT and CRT impact on late function, and if they do not improve survival in resectable cancers, can they be omitted in selected cases? KeywordsRectal adenocarcinoma, neoadjuvant radiation, chemoradiation, chemotherapy, short-course preoperative radiation, long-course chemoradiation Disclosure: Rob Glynne-Jones has received honoraria for lectures and advisory boards and has been supported in attending international meetings in the last five years by Eli Lilly, Merck, Pfizer, Sanofi-Aventis and Roche. He has received unrestricted grants for research from Merck-Serono, Sanofi-Aventis and Roche. He is principal investigator of a randomised phase II neoadjuvant chemotherapy study in the UK called BACCHUS. David Tan In patients with locally advanced rectal cancer (LARC), not involving the mesorectal fascia (MRF), surgery with total mesorectal excision (TME) is the standard of care. Prior to the TME era, high rates of local recurrence (LR) were observed after radical surgery, and 10-40 % of patients required a permanent stoma, even for tumours arising in the mid/upper rectum. In the 1990s, randomised trials 1-3 established shortcourse preoperative pelvic radiotherapy (SCPRT) using 5 x 5 Gy as a component of the curative treatment of resectable and early rectal cancers. These historical trials reported LR rates of 20-30 % after surgery alone, reflecting the suboptimal surgical practice at the time.Two subsequent trials examined whether SCPRT simply compensated for poor surgical technique, i.e. whether SCPRT still reduced LR if TME was performed. By then, it was recognised that the risk of LR, after a potentially curative resection, is mainly explained by microscopic tumour cells within 1 mm of the circumferential resection margin (CRM). 4 Hence, in the control group in the event of a histopathological involved CRM, postoperative RT or chemoradiotherapy was intended in the Dutch TME study 5 and CR07 trial,6 respectively. Both trials confirmed a reduction in LR, but overall survival (OS) was not improved, and the risk of metastases predominated over LR. [5][6][7][8] During the same period, the strategy of postoperativ...

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Preoperative chemoradiation vs radiation alone for stage II and III resectable rectal cancer: a meta‐analysis

Abstract: Preoperative ChRT for patients with stage II and III resectable rectal cancer gives better complete response rates compared with RT alone but it also results in higher toxicity.

Cited by 19 publications

References 38 publications

Preoperative conventional chemoradiotherapy versus short-course radiotherapy with delayed surgery for rectal cancer: results of a randomized controlled trial

Preoperative conventional chemoradiotherapy versus short-course radiotherapy with delayed surgery for rectal cancer: results of a randomized controlled trial

Identification of Predictors of Recurrence in Patients with Lower Rectal Cancer Undergoing Neoadjuvant Chemotherapy: A Direct Comparison of Short-Course and Long-Course Chemoradiotherapy

How to Select for Preoperative Short-course Radiotherapy, While Considering Long-course Chemoradiotherapy or Immediate Surgery, and Who Benefits?

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