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Postoperative Adjuvant Treatment Strategy for Locally Advanced Rectal Cancer after Neoadjuvant Treatment

BACKGROUND: Neoadjuvant (chemo) radiotherapy is used as a standard treatment for locally advanced rectal cancer (LARC), but there is no general consensus on either the efficacy of postoperative adjuvant chemotherapy in patients with LARC after neoadjuvant treatment and surgery, or whether the additi...

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Autores principales: Li, Jia-yi, Huang, Xuan-zhang, Gao, Peng, Chen, Xiao-wan, Song, Yong-xi, Lv, Xing-er, Fu, Yv, Xiao, Qiong, Wang, Zhen-ning
Formato: Online Artículo Texto
Lenguaje:English
Publicado: Hindawi 2021
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8319733/
https://www.ncbi.nlm.nih.gov/pubmed/34337057
http://dx.doi.org/10.1155/2021/8852699
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author Li, Jia-yi
Huang, Xuan-zhang
Gao, Peng
Chen, Xiao-wan
Song, Yong-xi
Lv, Xing-er
Fu, Yv
Xiao, Qiong
Wang, Zhen-ning
author_facet Li, Jia-yi
Huang, Xuan-zhang
Gao, Peng
Chen, Xiao-wan
Song, Yong-xi
Lv, Xing-er
Fu, Yv
Xiao, Qiong
Wang, Zhen-ning
author_sort Li, Jia-yi
collection PubMed
description BACKGROUND: Neoadjuvant (chemo) radiotherapy is used as a standard treatment for locally advanced rectal cancer (LARC), but there is no general consensus on either the efficacy of postoperative adjuvant chemotherapy in patients with LARC after neoadjuvant treatment and surgery, or whether the addition of oxaliplatin to adjuvant chemotherapy provides survival benefits. METHODS: We performed a meta-analysis of data from the PubMed and Embase databases. We included patients with LARC who received neoadjuvant (chemo) radiotherapy and curative surgery. Overall survival (OS), disease-free survival (DFS), toxicity, and compliance were analyzed in the oxaliplatin/fluorouracil- (OX/FU-) based group compared with the FU-based group, and in the chemotherapy group compared with the observation group. RESULTS: Twenty studies were included in the analysis. Our results indicated that adjuvant chemotherapy prolonged OS (hazard ratio [HR] = 0.78, 95%CI = 0.67–0.91) in patients with LARC treated with neoadjuvant (chemo) radiotherapy and surgery compared with those in the observation group. Subgroup analysis showed the same results in both the ypStage II and ypStage III groups. Compared with those in the observation group, patients in the chemotherapy group also showed an increase in DFS (HR = 0.75, 95%CI = 0.60–0.93). No significant increase was observed in OS (HR = 1.04, 95%CI = 0.87–1.24) or DFS (HR = 0.98, 95%CI = 0.76–1.27) when oxaliplatin was added to FU-based adjuvant chemotherapy, as compared with the FU-based treatment, and subgroup analysis also indicated no survival benefits in the clinical stage II, clinical stage III, ypStage II, and ypStage III groups. CONCLUSIONS: For patients with LARC who have already received neoadjuvant (chemo) radiotherapy and curative surgery, adjuvant chemotherapy improves OS over that in the observation group. Adding oxaliplatin to FU-based adjuvant chemotherapy does not confer survival benefits beyond those from FU-based adjuvant chemotherapy.
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spelling pubmed-83197332021-07-31 Postoperative Adjuvant Treatment Strategy for Locally Advanced Rectal Cancer after Neoadjuvant Treatment Li, Jia-yi Huang, Xuan-zhang Gao, Peng Chen, Xiao-wan Song, Yong-xi Lv, Xing-er Fu, Yv Xiao, Qiong Wang, Zhen-ning Biomed Res Int Research Article BACKGROUND: Neoadjuvant (chemo) radiotherapy is used as a standard treatment for locally advanced rectal cancer (LARC), but there is no general consensus on either the efficacy of postoperative adjuvant chemotherapy in patients with LARC after neoadjuvant treatment and surgery, or whether the addition of oxaliplatin to adjuvant chemotherapy provides survival benefits. METHODS: We performed a meta-analysis of data from the PubMed and Embase databases. We included patients with LARC who received neoadjuvant (chemo) radiotherapy and curative surgery. Overall survival (OS), disease-free survival (DFS), toxicity, and compliance were analyzed in the oxaliplatin/fluorouracil- (OX/FU-) based group compared with the FU-based group, and in the chemotherapy group compared with the observation group. RESULTS: Twenty studies were included in the analysis. Our results indicated that adjuvant chemotherapy prolonged OS (hazard ratio [HR] = 0.78, 95%CI = 0.67–0.91) in patients with LARC treated with neoadjuvant (chemo) radiotherapy and surgery compared with those in the observation group. Subgroup analysis showed the same results in both the ypStage II and ypStage III groups. Compared with those in the observation group, patients in the chemotherapy group also showed an increase in DFS (HR = 0.75, 95%CI = 0.60–0.93). No significant increase was observed in OS (HR = 1.04, 95%CI = 0.87–1.24) or DFS (HR = 0.98, 95%CI = 0.76–1.27) when oxaliplatin was added to FU-based adjuvant chemotherapy, as compared with the FU-based treatment, and subgroup analysis also indicated no survival benefits in the clinical stage II, clinical stage III, ypStage II, and ypStage III groups. CONCLUSIONS: For patients with LARC who have already received neoadjuvant (chemo) radiotherapy and curative surgery, adjuvant chemotherapy improves OS over that in the observation group. Adding oxaliplatin to FU-based adjuvant chemotherapy does not confer survival benefits beyond those from FU-based adjuvant chemotherapy. Hindawi 2021-03-28 /pmc/articles/PMC8319733/ /pubmed/34337057 http://dx.doi.org/10.1155/2021/8852699 Text en Copyright © 2021 Jia-yi Li et al. https://creativecommons.org/licenses/by/4.0/This is an open access article distributed under the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.
spellingShingle Research Article
Li, Jia-yi
Huang, Xuan-zhang
Gao, Peng
Chen, Xiao-wan
Song, Yong-xi
Lv, Xing-er
Fu, Yv
Xiao, Qiong
Wang, Zhen-ning
Postoperative Adjuvant Treatment Strategy for Locally Advanced Rectal Cancer after Neoadjuvant Treatment
title Postoperative Adjuvant Treatment Strategy for Locally Advanced Rectal Cancer after Neoadjuvant Treatment
title_full Postoperative Adjuvant Treatment Strategy for Locally Advanced Rectal Cancer after Neoadjuvant Treatment
title_fullStr Postoperative Adjuvant Treatment Strategy for Locally Advanced Rectal Cancer after Neoadjuvant Treatment
title_full_unstemmed Postoperative Adjuvant Treatment Strategy for Locally Advanced Rectal Cancer after Neoadjuvant Treatment
title_short Postoperative Adjuvant Treatment Strategy for Locally Advanced Rectal Cancer after Neoadjuvant Treatment
title_sort postoperative adjuvant treatment strategy for locally advanced rectal cancer after neoadjuvant treatment
topic Research Article
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8319733/
https://www.ncbi.nlm.nih.gov/pubmed/34337057
http://dx.doi.org/10.1155/2021/8852699
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