Pathological Complete Response Following Different Neoadjuvant Treatment Strategies for Locally Advanced Rectal Cancer:
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REVIEW ARTICLE – COLORECTAL CANCER
Pathological Complete Response Following Different Neoadjuvant Treatment Strategies for Locally Advanced Rectal Cancer: A Systematic Review and Meta-analysis S. Hoendervangers, MD1,2 , J. P. M. Burbach, MD, PhD3, M. M. Lacle, MD, PhD4, M. Koopman, MD, PhD5, W. M. U. van Grevenstein, MD, PhD2, M. P. W. Intven, MD, PhD1, and H. M. Verkooijen, MD, PhD1 1
Department of Radiation Oncology, University Medical Center Utrecht, Utrecht, The Netherlands; 2Department of Surgery, University Medical Center Utrecht, Utrecht, The Netherlands; 3Department of Surgery, MC Leeuwarden, Leeuwarden, The Netherlands; 4Department of Pathology, University Medical Center Utrecht, Utrecht, The Netherlands; 5 Department of Medical Oncology, University Medical Center Utrecht, Utrecht, The Netherlands
ABSTRACT Background. Pathological complete response (pCR) following neoadjuvant treatment for locally advanced rectal cancer (LARC) is associated with better survival, less local recurrence, and less distant failure. Furthermore, pCR indicates that the rectum may have been preserved. This meta-analysis gives an overview of available neoadjuvant treatment strategies for LARC and analyzes how these perform in achieving pCR as compared with the standard of care. Methods. Pubmed, Embase, and Cochrane Central bibliographic databases were searched. Randomized controlled trials in which patients received neoadjuvant treatment for MRI-staged nonmetastatic resectable LARC were included. The primary outcome was pCR, defined as ypT0N0. A meta-analysis of studies comparing an intervention with standard fluoropyrimidine-based chemoradiation (CRT) was performed. Results. Of the 17 articles included in the systematic review, 11 were used for the meta-analysis. Addition of oxaliplatin to fluoropyrimidine-based CRT resulted in
Electronic supplementary material The online version of this article (https://doi.org/10.1245/s10434-020-08615-2) contains supplementary material, which is available to authorized users. Ó The Author(s) 2020 First Received: 21 November 2019 S. Hoendervangers, MD e-mail: [email protected]
significantly more pCR compared with fluoropyrimidinebased CRT only (OR 1.46), but at the expense of more C grade 3 toxicity. Other treatment strategies, including consolidation/induction chemotherapy and short-course radiotherapy (SCRT), did not improve pCR rates. None of the included trials reported a benefit in local control or OS. Five-year DFS was significantly worse after SCRT-delay compared with CRT (59% vs. 75.1%, HR 1.93). Conclusions. All included trials fail to deliver high-level evidence to show an improvement in pCR compared with standard fluoropyrimidine-based CRT. The addition of oxaliplatin might result in more pCR but at the expense of more toxicity. Furthermore, this benefit does not translate into less local recurrence or improved survival.
The aim of rectal cancer treatment is to improve survival and prevent local recurrence, while limiting treatment-related morbidity and preserving bo
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