Neo-adjuvant chemotherapy alone for the locally advanced rectal cancer: a systematic review
- PDF / 731,594 Bytes
- 11 Pages / 595.276 x 790.866 pts Page_size
- 24 Downloads / 241 Views
REVIEW ARTICLE
Neo‑adjuvant chemotherapy alone for the locally advanced rectal cancer: a systematic review Dimitrios K . Manatakis1 · Nikolaos Gouvas2 · John Souglakos3 · Evangelos Xynos4 Received: 12 January 2020 / Accepted: 23 June 2020 © Japan Society of Clinical Oncology 2020
Abstract Neo-adjuvant chemoradiation (NA-CRT) is the standard of management for the locally advanced rectal cancer (LARC), achieving very low rates of local recurrence (LR). However, NA-CRT fails to control distant recurrence and improve survival, whilst it is associated with increased postoperative morbidity and increased acute and late toxicity. In recent years, neoadjuvant chemotherapy (NACTx) appears in the literature as an alternative to NA-CRT in patients with LARC. In the present study, the authors review all current evidence on the specific subject. Following a systematic search of the literature, 25 studies were identified reporting on short- or long-term outcomes of NACTx for LARC. Seventeen studies were prospective or retrospective series, and 8 comparative. Of the comparative studies, one was a randomized control trial (RCT) comparing NACTx to NA-CRT and to the combination of NACTx/NA-CRT, and another a non-randomized study comparing NACTx to NA-CRT. Chemotherapeutic regimens were 5-fluoropyrimidine and oxaliplatin based. In some of them, irinotecan or/and bevacizumab was added. A pooled analysis showed that NACTx is associated with a mean anastomotic leak rate of 6.8%. In the RCT, postoperative morbidity and overall toxicity was significantly less in the NACTx group. Mean T downstaging (ypStage 0–I) was 49.6%, mean N downstaging 69.6% and mean pathologic complete response (pCR) 10.7%. The RCT showed an inferior pCR rate after NACTx than after NA-CRT, but similar rates of T downstaging. Mean LR was 8.6% and mean distant recurrence 17.2%. Satisfactory survival rates are reported by several studies. NACTx seems to be an alternative to NA-CRT for patients with LARC, associated with low anastomotic leak, adequate tumour downstaging, low LR and rather high survival rates. Further data deriving from high-quality studies are necessary to assess safety and efficacy of NACTx as a substitute to NA-CRT, for at least a subset of patients with LARC. Keywords Rectal cancer · Locally advanced · Neo-adjuvant chemotherapy · Local recurrence
Introduction Surgery, in specific total mesorectal excision (TME), is the cornerstone of rectal cancer treatment. TME as the sole treatment for early and intermediate stage rectal cancer (cT1-2 and some cT3) achieves a local recurrence (LR) * Dimitrios K . Manatakis [email protected]; [email protected] 1
Department of Surgery, Athens Naval and Veterans Hospital, Athens, Greece
2
Department of Surgery, Medical School, University of Cyprus, Nicosia, Cyprus
3
Department of Medical Oncology, Medical School, University of Crete, Heraklion, Greece
4
Department of Surgery, Creta Interclinic Hospital, Heraklion, Greece
rate well below 10% [1, 2]. Even more recently, treatment of rectal ca
Data Loading...
