Short-course versus long-course neoadjuvant radiotherapy combined with delayed surgery for locally advanced rectal cancer:a Meta-analysis
Xu Xingyu1, Dong Yaqin2, Yang Lin2, Xiong Maoming1
1Department of Gastroenterology Surgery First Affiliated Hospital Anhui Medical University Hefei 230000 Cina; 2Department of Radiation Oncology First Affiliated Hospital Anhui Medical University Hefei 230000 Cina
Abstract：Objective Short-course neoadjuvant radiotherapy (SCRT) combined with delayed surgery seems to be safer than SCRT in combination with immediate surgery. However,the clinical efficacy between SCRT and long-course neoadjuvant radiotherapy (LCRT) combined with delayed surgery has not been compared. Therefore, this meta-analysis was performed to compare the safety and efficacy between SCRT and LCRT followed by delayed surgery in patients with locally advanced rectal cancer. Methods Relevant literatures were searched using relevant databases. Baseline characteristics and treatment results of patients were extracted. The included studies were subject to bias risk assessment. Evidence assessment and data analysis were conducted. Results A total of 7 studies with 4967 patients were included. Meta-analysis results illustrated no statistical significance between two groups in terms of sphincter preservation rate,R0 resection rate,postoperative complications,local recurrence rate (LRR),distant metastasis,recurrence-free survival (RFS),overall survival (OS),length of hospital stay and acute radiotherapy toxicity (all P>0.05). Compared with SCRT with delayed surgery,LCRT with delayed surgery was associated with a significant increase in the tumor downstaging rate (RR=0.84,95%CI=0.76-0.93,P<0.05) and a considerable increase in pathologically complete remission rate (RR=0.46,95%CI=0.34-0.61,P<0.05). Conclusions SCRT with delayed surgery is as effective as LCRT with delayed surgery in terms of sphincter preservation rate,R0 resection rate,postoperative complications,LRR,RFS,OS,grade Ⅲ-Ⅳ acute toxicity and length of hospital stay. However, LCRT in combination with delayed surgery enhances the tumor downstaging rate and pathologically complete remission rate.
Xu Xingyu,Dong Yaqin,Yang Lin et al. Short-course versus long-course neoadjuvant radiotherapy combined with delayed surgery for locally advanced rectal cancer:a Meta-analysis[J]. Chinese Journal of Radiation Oncology, 2019, 28(12): 901-904.
[1]Siegel RL,Miller KD,Jemal A. Cancer statistics,2016. CA[J]. Cancer J Clin,2016,66(1):7-30. DOI:10.3322/caac.21332. [2]Mowery YM,Salama JK,Zafar SY,et al. Neoadjuvant long-course chemoradiation remains strongly favored over short-course radiotherapy by radiation oncologists in the United States[J]. Cancer Soci,2017,123(8):1434-1441. DOI:10.1002/cncr.30461. [3]Bujko K,Nowacki MP,Nasierowska-Guttmejer A,et al. Long-term results of a randomized trial comparing preoperative short-course radiotherapy with preoperative conventionally fractionated chemoradiation for rectal cancer[J]. Br J Surg,2006,93(10):1215-1223. DOI:10.1002/bjs.5506. [4]Ngan SY,Burmeister B,Fisher RJ,et al. Randomized trial of short-course radiotherapy versus long-course chemoradiation comparing rates of local recurrence in patients with T3 rectal cancer:trans-tasman radiation oncology group trial 01.04[J]. J Clin Oncol,2012,30(31):3827-3833. DOI:10.1200/JCO.2012.42.9597. [5]Pettersson D,Cedermark B,Holm T,et al. Interim analysis of the stockholm Ⅲ trial of preoperative radiotherapy regimens for rectal cancer[J]. Br J Surg,2010,97(4):580-587. DOI:10.1002/bjs.6914. [6]Hatfield P,Hingorani M,Radhakrishna G,et al. Short-course radiotherapy,with elective delay prior to surgery,in patients with unresectable rectal cancer who have poor performance status or significant co-morbidity[J]. Radiother Oncol,2009,92(2):210-214. DOI:10.1016/j.radonc.2009.04.007. [7]Radu C,Berglund K,Hlman L,et al. Short-course preoperative radiotherapy with delayed surgery in rectal cancer-a retrospective study[J]. Radiother Oncol,2008,87(3):343-349. DOI:10.1016/j.radonc.2007.11.025. [8]Shuster JJ. Review:cochrane handbook for systematic reviews for interventions,version 5.1.0,published 3/2011. Julian P. T. Higgins and Sally Green,Editors[J]. Res Synth Methods,2011,2(2):126-130. DOI:10.1002/jrsm.38. [9]Guyatt GH,Oxman AD,Vist GE,et al. GRADE:an emerging consensus on rating quality of evidence and strength of recommendations[J]. BMJ,2008,336(7650):924-926. DOI:10.1136/bmj.39489.470347. AD. [10]Balshem H,Helfand M,Schünemann HJ,et al. Grade guidelines:3. Rating the quality of evidence[J]. J Clin Epidemiol,2011,64(4):401-406. DOI:10.1016/j.jclinepi.2010.07.015. [11]Beppu N,Matsubara N,Noda M,et al. Short-course radiotherapy with delayed surgery versus conventional chemoradiotherapy:a comparison of the short-and long-term outcomes in patients with T3 rectal cancer[J]. Surgery,2015,158(1):225-235. DOI:10.1016/j.surg.2015.03.014. [12]Bujko K,Richter P,Smith FM,et al. Preoperative radiotherapy and local excision of rectal cancer with immediate radical re-operation for poor responders:A prospective multicentre study[J]. Radiother Oncol,2013,106(2):198-205. DOI:10.1016/j.radonc.2012.12.005. [13]Chung MJ,Kim DW,Chung WK,et al. Preoperative short-vs.long-course chemoradiotherapy with delayed surgery for locally advanced rectal cancer[J]. Oncotarget,2016,8(36):60479-60486. DOI:10.18632/oncotarget.10280. [14]Erlandsson J,Holm TR,Pettersson D,et al. Optimal fractionation of preoperative radiotherapy and timing to surgery for rectal cancer (stockholm Ⅲ):a multicentre,randomised,non-blinded,phase 3,non-inferiority trial[J]. Lancet Oncol,2017,18(3):336-346. DOI:10.1016/S1470-2045(17)30086-4. [15]Kairevi$\hat{c}$è L,Latkauskas T,Tamelis A,et al. Preoperative long-course chemoradiotherapy plus adjuvant chemotherapy versus short-course radiotherapy without adjuvant chemotherapy both with delayed surgery for stage Ⅱ–Ⅲ resectable rectal cancer:5-year survival data of a randomized controlled trial[J]. Medicina,2017,53(3):150-158. DOI:10.1016/j.medici.2017.05.006. [16]Latkauskas T,Pauzas H,Kairevi$\hat{c}$è L,et al. Preoperative conventional chemoradiotherapy versus short-course radiotherapy with delayed surgery for rectal cancer:results of a randomized controlled trial[J]. BMC Cancer,2016,16(1):927. DOI:10.1186/s12885-016-2959-9. [17]Hoendervangers S,Couwenberg AM,Intven MPW,et al. Comparison of pathological complete response rates after neoadjuvant short-course radiotherapy or chemoradiation followed by delayed surgery in locally advanced rectal cancer[J]. Eur J Surg Oncol,2018,44(7):1013-1017. DOI:10.1016/j.ejso.2018.03.014. [18]Liu S,Zhou Z,Chen L,et al. Short-course versus long-course preoperative radiotherapy plus delayed surgery in the treatment of rectal cancer:a Meta-analysis[J]. As Paci J Cancer Prev,2015,16(14):5755-5762. DOI:10.7314/apjcp.2015.16.14.5755. [19]Francois Y,Nemoz CJ,Baulieux J,et al. Influence of the interval between preoperative radiation therapy and surgery on downstaging and on the rate of sphincter-sparing surgery for rectal cancer:the lyon R90-01 randomized trial[J].1999,17(8):2396. DOI:10.1200/JCO.1999.17.8.2396 [20]Ngan SY,Burmeister B,Fisher RJ,et al. Randomized trial of short-course radiotherapy versus long-course chemoradiation comparing rates of local recurrence in patients with T3 rectal cancer:trans-tasman radiation oncology group trial 01.04[J]. J Clin Oncol,2012,30(31):3827-3833. DOI:10.1200/JCO.2012.42.9597. [21]Valentini V,Glimelius B,Minsky BD,et al. The multidisciplinary rectal cancer treatment:Main convergences,controversial aspects and investigational areas which support the need for an European Consensus[J]. Radiother Oncol,2005,76(3):241-250. DOI:10.1016/j.radonc.2005.07.001. [22]Courdi A. Fractionation sensitivity and equivalent doses. Commenting on the editorial by Glimelius[J]. Acta Oncol,2007,46(3):395-396. DOI:10.1080/02841860701261576. [23]Glimelius B. Rectal cancer irradiation. Long course,short course or something else？[J]. Acta Oncol,2006,45(8):1013-1017. DOI:10.1080/02841860601019413. [24]Gérard J,Conroy T,Bonnetain F,et al. Preoperative radiotherapy with or without concurrent fluorouracil and leucovorin in T3-T4 rectal cancers:results of FFCD 9203[J]. J Clin Oncol,2006,24(28):4620-4625. DOI:10.1200/JCO.2006.06.7629. [25]Yeo S,Oh JH,Kim DY,et al. Preoperative short-course concurrent chemoradiation therapy followed by delayed surgery for locally advanced rectal cancer:a phase 2 multicenter study (KROG 10-01)[J]. Int J Radiat Oncol Biol Phys,2013,86(1):34-39. DOI:10.1016/j.ijrobp.2012.11.018.
2019, Vol. 28 
