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Pathological Complete Response Following Different Neoadjuvant Treatment Strategies for Locally Advanced Rectal Cancer: A Systematic Review and Meta-analysis

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...

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Autores principales: Hoendervangers, S., Burbach, J. P. M., Lacle, M. M., Koopman, M., van Grevenstein, W. M. U., Intven, M. P. W., Verkooijen, H. M.
Formato: Online Artículo Texto
Lenguaje:English
Publicado: Springer International Publishing 2020
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7497700/
https://www.ncbi.nlm.nih.gov/pubmed/32524461
http://dx.doi.org/10.1245/s10434-020-08615-2
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author Hoendervangers, S.
Burbach, J. P. M.
Lacle, M. M.
Koopman, M.
van Grevenstein, W. M. U.
Intven, M. P. W.
Verkooijen, H. M.
author_facet Hoendervangers, S.
Burbach, J. P. M.
Lacle, M. M.
Koopman, M.
van Grevenstein, W. M. U.
Intven, M. P. W.
Verkooijen, H. M.
author_sort Hoendervangers, S.
collection PubMed
description 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 significantly more pCR compared with fluoropyrimidine-based CRT only (OR 1.46), but at the expense of more ≥ 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. ELECTRONIC SUPPLEMENTARY MATERIAL: The online version of this article (10.1245/s10434-020-08615-2) contains supplementary material, which is available to authorized users.
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spelling pubmed-74977002020-09-28 Pathological Complete Response Following Different Neoadjuvant Treatment Strategies for Locally Advanced Rectal Cancer: A Systematic Review and Meta-analysis Hoendervangers, S. Burbach, J. P. M. Lacle, M. M. Koopman, M. van Grevenstein, W. M. U. Intven, M. P. W. Verkooijen, H. M. Ann Surg Oncol Colorectal Cancer 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 significantly more pCR compared with fluoropyrimidine-based CRT only (OR 1.46), but at the expense of more ≥ 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. ELECTRONIC SUPPLEMENTARY MATERIAL: The online version of this article (10.1245/s10434-020-08615-2) contains supplementary material, which is available to authorized users. Springer International Publishing 2020-06-10 2020 /pmc/articles/PMC7497700/ /pubmed/32524461 http://dx.doi.org/10.1245/s10434-020-08615-2 Text en © The Author(s) 2020 Open AccessThis article is licensed under a Creative Commons Attribution 4.0 International License, which permits use, sharing, adaptation, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons licence, and indicate if changes were made. The images or other third party material in this article are included in the article's Creative Commons licence, unless indicated otherwise in a credit line to the material. If material is not included in the article's Creative Commons licence and your intended use is not permitted by statutory regulation or exceeds the permitted use, you will need to obtain permission directly from the copyright holder. To view a copy of this licence, visit http://creativecommons.org/licenses/by/4.0/.
spellingShingle Colorectal Cancer
Hoendervangers, S.
Burbach, J. P. M.
Lacle, M. M.
Koopman, M.
van Grevenstein, W. M. U.
Intven, M. P. W.
Verkooijen, H. M.
Pathological Complete Response Following Different Neoadjuvant Treatment Strategies for Locally Advanced Rectal Cancer: A Systematic Review and Meta-analysis
title Pathological Complete Response Following Different Neoadjuvant Treatment Strategies for Locally Advanced Rectal Cancer: A Systematic Review and Meta-analysis
title_full Pathological Complete Response Following Different Neoadjuvant Treatment Strategies for Locally Advanced Rectal Cancer: A Systematic Review and Meta-analysis
title_fullStr Pathological Complete Response Following Different Neoadjuvant Treatment Strategies for Locally Advanced Rectal Cancer: A Systematic Review and Meta-analysis
title_full_unstemmed Pathological Complete Response Following Different Neoadjuvant Treatment Strategies for Locally Advanced Rectal Cancer: A Systematic Review and Meta-analysis
title_short Pathological Complete Response Following Different Neoadjuvant Treatment Strategies for Locally Advanced Rectal Cancer: A Systematic Review and Meta-analysis
title_sort pathological complete response following different neoadjuvant treatment strategies for locally advanced rectal cancer: a systematic review and meta-analysis
topic Colorectal Cancer
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7497700/
https://www.ncbi.nlm.nih.gov/pubmed/32524461
http://dx.doi.org/10.1245/s10434-020-08615-2
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