Meta-analysis of randomized controlled trials of neoadjuvant radiotherapy and chemoradiotherapy combined with TME surgery for locally advanced rectal cancer

doi:10.3877/cma.j.issn.1674-3946.2018.06.012

Abstract

Abstract:

Objective

to evaluate the safety and efficacy of neoadjuvant radiotherapy and neoadjuvant chemoradiotherapy combined with total mesorectal excision (TME) in the treatment for locally advanced rectal cancer.

Methods

Database including PubMed, ovid, Cochrane library, Chinese biomedical literature database ( CBM ), CNKI and Wanfang were retrieved from 2002 to 2017 on neoadjuvant therapy combined with TME surgery for locally advanced rectal cancer.The quality of the literatures that met the inclusion criteria were evaluated. Revman 5.0 software was used to examine the heterogeneity and meta-analysis was performed.

Results

A total of 4 randomized controlled trials involving 2272 rectal cancer patients were included in the study. There were 1133 patients in the neoadjuvant chemoradiotherapy group and 1139 patients in the neoadjuvant radiotherapy group. Compared with the neoadjuvant chemoradiotherapy y group, the complete pathological remission rate was lower in neoadjuvant radiotherapy group (OR=0.32, 95 % CI: 0.22-0.44, P<0.05 ), with higher 5-years local recurrence rate (OR=2.13, 95 % CI: 1.62-2.79, P<0.05 ), however with less serious adverse reactions (OR=0.38, 95 % CI: 0.17-0.82, P=0.01), with statistically significant difference. However, there was no significant difference of anus-preserving rate, postoperative complication rate, 5-years disease-free survival rate and overall survival rate.

Conclusion

Neoadjuvant chemoradiotherapy is generally superior to neoadjuvant radiotherapy alone in the treatment for advanced rectal cancer, but it is still necessary to choose a suitable neoadjuvant treatment plan according to the patient’s tolerance in clinical application.

Key words: Rectal Neoplasms, Mesentery, Radiotherapy, Adjuvant, Chemotherapy, Adjuvant, Meta-Analysis

jiachen Sun, junrong Chen, Ming Guang Lai. Meta-analysis of randomized controlled trials of neoadjuvant radiotherapy and chemoradiotherapy combined with TME surgery for locally advanced rectal cancer[J]. Chinese Journal of Operative Procedures of General Surgery(Electronic Edition), 2018, 12(06): 485-489.

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URL: https://zhpwkssxzz.cma-cmc.com.cn/EN/10.3877/cma.j.issn.1674-3946.2018.06.012

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Figures/Tables 12

References 21

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研究项目	国家	时期	处理	病例数	平均年龄	治疗方案	生物效应剂量	间隔时间	随访时间	Jadad评分
Gerard 2006^[5]	France	1993～2003	RT	367	63	45Gy/25fr	37.5Gy	3～10周	81月	3
?	?	?	CRT	375	64	45Gy/25fr加5－FU＋LV	37.5Gy	?	?	?
Bosset 2006^[4]	France	1993～2003	RT	505	63	45Gy/25fr	37.5Gy	5周	5.4年	3
?	?	?	CRT	506	63	45Gy/25fr加5－FU＋LV	37.5Gy	?	?	?
Bujko 2006^[6]	Poland	1999～2002	RT	155	?	25Gy/5fr	38.7Gy	7 d	48月	3
?	?	?	CRT	157	?	50.4Gy/28fr加5－FU＋LV	40.9Gy	4～6周	?	?
Pouanet 2006^[7]	France	2001～2005	RT	106	?	45Gy加18Gy	－	－	22月	2
?	?	?	CRT	101	?	45Gy加5－FU	－	?	?	?
BRCT^[8]	Germany	2004－	RT	?	?	25Gy/5fr	38.7Gy	?	?	?
?	?	?	CRT	?	?	50.4Gy/28fr加5－FU	40.9Gy	?	?	?
TROG/AGITG^[9]	Australia	RT	?	?	?	25Gy/5fr	38.7Gy	?	?	?
?	?	?	CRT	?	?	50.4Gy/28fr加5－FU	40.9Gy	?	?	?
CPPKU^[10]	Lithuania	RT	?	?	?	25Gy/5fr	38.7Gy	?	?	?
?	?	?	CRT	?	?	50Gy/28fr加5－FU	40.2Gy	?	?	?

研究项目	国家	时期	处理	病例数	平均年龄	治疗方案	生物效应剂量	间隔时间	随访时间	Jadad评分
Gerard 2006^[5]	France	1993～2003	RT	367	63	45Gy/25fr	37.5Gy	3～10周	81月	3
?	?	?	CRT	375	64	45Gy/25fr加5－FU＋LV	37.5Gy	?	?	?
Bosset 2006^[4]	France	1993～2003	RT	505	63	45Gy/25fr	37.5Gy	5周	5.4年	3
?	?	?	CRT	506	63	45Gy/25fr加5－FU＋LV	37.5Gy	?	?	?
Bujko 2006^[6]	Poland	1999～2002	RT	155	?	25Gy/5fr	38.7Gy	7 d	48月	3
?	?	?	CRT	157	?	50.4Gy/28fr加5－FU＋LV	40.9Gy	4～6周	?	?
Pouanet 2006^[7]	France	2001～2005	RT	106	?	45Gy加18Gy	－	－	22月	2
?	?	?	CRT	101	?	45Gy加5－FU	－	?	?	?
BRCT^[8]	Germany	2004－	RT	?	?	25Gy/5fr	38.7Gy	?	?	?
?	?	?	CRT	?	?	50.4Gy/28fr加5－FU	40.9Gy	?	?	?
TROG/AGITG^[9]	Australia	RT	?	?	?	25Gy/5fr	38.7Gy	?	?	?
?	?	?	CRT	?	?	50.4Gy/28fr加5－FU	40.9Gy	?	?	?
CPPKU^[10]	Lithuania	RT	?	?	?	25Gy/5fr	38.7Gy	?	?	?
?	?	?	CRT	?	?	50Gy/28fr加5－FU	40.2Gy	?	?	?

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