Year 2019 / Volume 111 / Number 1
Original
Comparison of long course and short course preoperative radiotherapy in the treatment of locally advanced rectal cancer: a systematic review and meta-analysis

17-27

DOI: 10.17235/reed.2018.5674/2018

Yongjun Yu, Yuwei Li, Chen Xu, Zhao Zhang, Xipeng Zhang,

Abstract
Background: rectal cancer (RC) is one of the most prevalent malignancies worldwide and different preoperative radiotherapies may lead to different outcomes. This meta-analysis aimed to compare the effectiveness of long-course (LC) and short-course radiotherapy (SC), with or without chemotherapy, for locally advanced rectal cancer. Methods: studies published up to March 31st 2018 were retrieved from PubMed, Medline, Cochrane and EMABSE. Randomized control or consort control trials that reported the outcomes of short or long course radiotherapy were eligible. Either a fixed or random effects model was used to access the overall combined risk estimates. Results: sixteen studies with a total of 2,773 RC patients were included in the analysis. There were no significant differences between LC and SC therapies with regard to the following: pathological complete response (PCR) (I2 = 78%, p < 0.05, RR = 0.54, 95% CI: 0.26-1.10); tumor downstaging (I2 = 79%, p < 0.05, RR = 0.83, 95% CI: 0.58-1.17); local recurrences (I2 = 22%, p = 0.27, RR = 0.55, 95% CI: 0.26-1.16); distant metastases (I2 = 29%, p = 0.22, RR = 1.03, 95% CI: 0.77-1.37); mortality (I2 = 0%, p = 0.78, RR = 0.95, 95% CI: 0.78-1.15) and serious late toxicity (I2 = 74%, p = 0.01, RR = 1.10, 95% CI: 0.37-3.26). In the subgroup analysis, LC had a better PCR and tumor downstaging rate compared with SC in the RCT subgroup. Besides, LC also presented a better PCR rate compared with SC without chemotherapy. Conclusions: LC and SC are both effective in the preoperative treatment of RC with regard to PCR, tumor downstaging, local recurrences, distant metastases, mortality and serious late toxicity. Furthermore, chemotherapy may enhance the efficacy of preoperative treatment.
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References
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3. Hartley A, Giridharan S, Srihari N, et al. Impaired postoperative neutrophil leucocytosis and acute complications following short course preoperative radiotherapy for operable rectal cancer. Eur J Surg Oncol 2003;29(2):155-7.
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11. Listed N. Initial report from a Swedish multicentre study examining the role of preoperative irradiation in the treatment of patients with resectable rectal carcinoma. Br J Surg 2010;80(10):1333-6.
12. Marijnen CAM, Kapiteijn E, Velde CJHVD, et al. Acute Side Effects and Complications After Short-Term Preoperative Radiotherapy Combined With Total Mesorectal Excision in Primary Rectal Cancer: Report of a Multicenter Randomized Trial. J Clin Oncol 2002;20(3):817-25.
13. 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. Br J Surg 2006;93(10):1215-23.
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15. Mi JC, Dong WK, Chung WK, et al. Preoperative short- vs. long-course chemoradiotherapy with delayed surgery for locally advanced rectal cancer. Oncotarget 2016;8(36):60479-86.
16. Eitta MA, El-Wahidi GF, Fouda MA, et al. Preoperative radiotherapy in resectable rectal cancer: a prospective randomized study of two different approaches. J Egypt Natl Canc Inst 2010;22(3):155-64.
17. Kairevičė 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. Medicina 2017.
18. Krajcovicova I, Bolješíková E, Sandorova M, et al. Preoperative radiotherapy of locally advanced rectal cancer: clinical outcome of short-course and long-course treatment with or without concomitant chemotherapy. Klin Onkol 2012;25(5):364.
19. Latkauskas T, Pauzas H, Gineikiene I, et al. Initial results of a randomized controlled trial comparing clinical and pathological downstaging of rectal cancer after preoperative short‐course radiotherapy or long‐term chemoradiotherapy, both with delayed surgery. Colorectal Dis 2012;14(3):294-8.
20. Lee SW, Lee JH, Lee IK, et al. The Impact of Surgical Timing on Pathologic Tumor Response after Short Course and Long Course Preoperative Chemoradiation for Locally Advanced Rectal Adenocarcinoma. Cancer Res Treat 2017;45(2):781-91.
21. Markovina S, Youssef F, Roy A, et al. Improved Metastasis- and Disease-Free Survival With Preoperative Sequential Short-Course Radiation Therapy and FOLFOX Chemotherapy for Rectal Cancer Compared With Neoadjuvant Long-Course Chemoradiotherapy: Results of a Matched Pair Analysis. Int J Radiat Oncol Biol Phys 2017;99(2):417-26.
22. Read TE, Mcnevin MS, Gross EK, et al. Neoadjuvant therapy for adenocarcinoma of the rectum: tumor response and acute toxicity. Dis Colon Rectum 2001;44(4):513-22.
23. 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 Clin Oncol 2012;30(31):3827-33.
24. Vironen J, Juhola M, Kairaluoma M, et al. Tumour regression grading in the evaluation of tumour response after different preoperative radiotherapy treatments for rectal carcinoma. Int J Colorectal Dis 2005;20(5):440-5.
25. Yeh CH, Chen MF, Lai CH, et al. Comparison of treatment results between surgery alone, preoperative short-course radiotherapy, or long-course concurrent chemoradiotherapy in locally advanced rectal cancer. Int J Clin Oncol 2012;17(5):482-90.
26. Ansari N, Solomon MJ, Fisher RJ, et al. Acute Adverse Events and Postoperative Complications in a Randomized Trial of Preoperative Short-course Radiotherapy Versus Long-course Chemoradiotherapy for T3 Adenocarcinoma of the Rectum: Trans-Tasman Radiation Oncology Group Trial (TROG 01.04). Ann Surg 2017;265(5):882.
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32. Birgisson H, Pã¥Hlman L, Gunnarsson U, et al. Adverse effects of preoperative radiation therapy for rectal cancer: long-term follow-up of the Swedish Rectal Cancer Trial. J Clin Oncol 2005;23(34):8697-705.
33. Pettersson D, Holm T, Iversen H, et al. Preoperative short-course radiotherapy with delayed surgery in primary rectal cancer. Br J Surg 2012;99(4):577-83.
34. Bosset JF, Calais G, Mineur L, et al. Preoperative radiation (Preop RT) in rectal cancer: Effect and timing of additional chemotherapy (CT) 5-year results of the EORTC 22921 trial. J Clin Oncol 2005;23(16):247S.
35. Gérard JP, Conroy T, Bonnetain F, et al. Preoperative radiotherapy with or without concurrent fluorouracil and leucovorin in T3-4 rectal cancers: results of FFCD 9203. J Clin Oncol 2006;24(28):4620-5.
36. S. BOULIS-WASSIF FAG, J. LOYGUE, D. CAMELOT, M. BUYSE, N. DUEZlI. Final Results of a Randomized Trial on the Treatment of Rectal Cancer With Preoperative Radiotherapy Alone or in Combination With 5-Fluorouracil, Followed by Radical Surgery. Trial of the European Organization on Research and Treatment of Cancer Gastrointestinal Tract Cancer Cooperative Group. Cancer;53:1811-8.
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Yu Y, Li Y, Xu C, Zhang Z, Zhang X. Comparison of long course and short course preoperative radiotherapy in the treatment of locally advanced rectal cancer: a systematic review and meta-analysis. 5674/2018


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Publication history

Received: 25/04/2018

Accepted: 29/06/2018

Online First: 04/10/2018

Published: 17/01/2019

Article revision time: 63 days

Article Online First time: 162 days

Article editing time: 267 days


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