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Induction chemotherapy followed by neoadjuvant chemoradiotherapy and surgery for patients with locally advanced rectal cancer: a systematic review and meta-analysis.
- Source :
-
International journal of colorectal disease [Int J Colorectal Dis] 2020 Aug; Vol. 35 (8), pp. 1355-1369. Date of Electronic Publication: 2020 Jun 01. - Publication Year :
- 2020
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Abstract
- Background: Controversy persists about whether additional induction chemotherapy (ICT) before neoadjuvant chemoradiation (NCRT) yields improved oncological outcomes. We performed a systematic review and meta-analysis to compare ICT+ NCRT+ surgery(S) with NCRT+ S in patients with locally advanced rectal cancer (LARC).<br />Methods: We searched the PubMed, EMBASE, Cochrane Library, and China Biology Medicine (CBM) databases. The data were analyzed with Stata version 12.0 software.<br />Results: We identified 9 relevant trials that enrolled 1538 patients. We detected no significant difference in the 5-year overall survival (OS) (OR 1.50, 95% CI 0.48-4.64), disease-free survival (DFS) (OR 1.03, 95% CI 0.73-1.46), local recurrence (LR) (OR 0.80, 95% CI 0.45-1.43), and distant metastasis (DM) rates (OR 1.03, 95% CI 0.55-1.93) between patients who did and did not receive ICT. The addition of ICT before NCRT had a similar pathological complete response rate compared to NCRT (OR 1.26, 95% CI 0.90-1.77). Our findings suggest that between the ICT + NCRT+S and NCRT+S groups, ICT improved the incidence of grade 3 to 4 toxicity effects (OR 4.81, 95% CI 2.38-9.37), but between the ICT + NCRT+S and NCRT+S+ adjuvant chemotherapy (ACT) groups, ICT might reduce toxicity (OR 0.19, 95% CI 0.08-0.50). ICT had no significant impact on surgical complications (OR 0.97, 95% CI 0.63-1.51).<br />Conclusions: The addition of ICT before NCRT seemingly shows no survival benefit on patients with LARC, and might increase the toxicity.
Details
- Language :
- English
- ISSN :
- 1432-1262
- Volume :
- 35
- Issue :
- 8
- Database :
- MEDLINE
- Journal :
- International journal of colorectal disease
- Publication Type :
- Academic Journal
- Accession number :
- 32488419
- Full Text :
- https://doi.org/10.1007/s00384-020-03621-y