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Comparison of different chemoradiotherapy regimens for the preoperative treatment in patients with locally advanced rectal cancer: a network meta-analysis
BACKGROUND: The efficacy of different neoadjuvant chemoradiotherapy regimens on locally advanced rectal cancer (LARC) remains confusing. We evaluated them together via a network meta-analysis in terms of survival benefits to find the optimal treatment. METHODS: We searched, EMBASE, Cochrane Central...
Autores principales: | , , , , , |
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Formato: | Online Artículo Texto |
Lenguaje: | English |
Publicado: |
AME Publishing Company
2020
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Materias: | |
Acceso en línea: | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8798459/ https://www.ncbi.nlm.nih.gov/pubmed/35117848 http://dx.doi.org/10.21037/tcr-20-683 |
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author | Yu, Zhengyi Wang, Jiawei Xu, Lingyan Liu, Jin Chen, Xiaofeng Gu, Yanhong |
author_facet | Yu, Zhengyi Wang, Jiawei Xu, Lingyan Liu, Jin Chen, Xiaofeng Gu, Yanhong |
author_sort | Yu, Zhengyi |
collection | PubMed |
description | BACKGROUND: The efficacy of different neoadjuvant chemoradiotherapy regimens on locally advanced rectal cancer (LARC) remains confusing. We evaluated them together via a network meta-analysis in terms of survival benefits to find the optimal treatment. METHODS: We searched, EMBASE, Cochrane Central Register of Controlled Trials and the ClinicalTrials website according to the selection criteria for eligible publications before Oct 25, 2019. Pathological complete response rate (pCR), disease-free survival (DFS), and overall survival (OS) were analyzed based on Bayesian methods in the meta-analysis. RESULTS: Twenty-five articles containing 7,142 participants and 12 preoperative regimens were analyzed. In terms of pCR, radiation therapy plus 5-fluorouracil (RT+5-Fu), RT plus capecitabine (RT+CAPE), RT plus 5-fluorouracil and oxaliplatin (RT+FOLFOX), RT plus capecitabine and oxaliplatin (RT+XELOX), and RT plus S-1 and irinotecan (RT+IS) were better than RT alone [odds ratio (OR) =2.66, 95% credible interval [CrI], 1.38–5.01; OR =3.11, 95% CrI: 1.33–6.98; OR =4.03, 95% CrI: 1.77–9.47; OR =4.22, 95% CrI: 1.60–10.87; OR =4.55, 95% CrI: 1.11–18.88, respectively] and RT+FOLFOX and RT+XELOX were superior to FOLFOX (OR =4.58, 95% CrI: 1.57–14.19; OR =4.81, 95% CrI: 1.20–18.73), too. Benefits could be seen on comparing RT+CAPE, RT+FOLFOX, and RT+XELOX with RT (OR =0.84, 95% CrI: 0.73–0.97; OR =0.88, 95% CrI: 0.80–0.97; OR =0.79, 95% CrI: 0.66–0.95, respectively) in DFS. RT+XELOX seemed to have better effects on OS compared than RT+5-Fu and RT+CAPE (OR =0.78, 95% CrI: 0.61–1.00; OR =0.86, 95% CrI: 0.74–1.00, respectively). Moreover, according to surface under the cumulative ranking curve analysis, RT+XELOX had the best outcomes in terms of pCR (79.18%) and OS (83.49%) and RT plus capecitabine, irinotecan, and cetuximab (RT+XELIRI+CET) ranked first with respect to DFS (87.86%). CONCLUSIONS: RT+XELOX is likely to be the best treatment with a comprehensive curative effect and the standard treatment of 5-fluorouracil-based chemoradiotherapy has some advantages, as well. More relevant evidence is needed for clinicians’ guidance. |
format | Online Article Text |
id | pubmed-8798459 |
institution | National Center for Biotechnology Information |
language | English |
publishDate | 2020 |
publisher | AME Publishing Company |
record_format | MEDLINE/PubMed |
spelling | pubmed-87984592022-02-02 Comparison of different chemoradiotherapy regimens for the preoperative treatment in patients with locally advanced rectal cancer: a network meta-analysis Yu, Zhengyi Wang, Jiawei Xu, Lingyan Liu, Jin Chen, Xiaofeng Gu, Yanhong Transl Cancer Res Original Article BACKGROUND: The efficacy of different neoadjuvant chemoradiotherapy regimens on locally advanced rectal cancer (LARC) remains confusing. We evaluated them together via a network meta-analysis in terms of survival benefits to find the optimal treatment. METHODS: We searched, EMBASE, Cochrane Central Register of Controlled Trials and the ClinicalTrials website according to the selection criteria for eligible publications before Oct 25, 2019. Pathological complete response rate (pCR), disease-free survival (DFS), and overall survival (OS) were analyzed based on Bayesian methods in the meta-analysis. RESULTS: Twenty-five articles containing 7,142 participants and 12 preoperative regimens were analyzed. In terms of pCR, radiation therapy plus 5-fluorouracil (RT+5-Fu), RT plus capecitabine (RT+CAPE), RT plus 5-fluorouracil and oxaliplatin (RT+FOLFOX), RT plus capecitabine and oxaliplatin (RT+XELOX), and RT plus S-1 and irinotecan (RT+IS) were better than RT alone [odds ratio (OR) =2.66, 95% credible interval [CrI], 1.38–5.01; OR =3.11, 95% CrI: 1.33–6.98; OR =4.03, 95% CrI: 1.77–9.47; OR =4.22, 95% CrI: 1.60–10.87; OR =4.55, 95% CrI: 1.11–18.88, respectively] and RT+FOLFOX and RT+XELOX were superior to FOLFOX (OR =4.58, 95% CrI: 1.57–14.19; OR =4.81, 95% CrI: 1.20–18.73), too. Benefits could be seen on comparing RT+CAPE, RT+FOLFOX, and RT+XELOX with RT (OR =0.84, 95% CrI: 0.73–0.97; OR =0.88, 95% CrI: 0.80–0.97; OR =0.79, 95% CrI: 0.66–0.95, respectively) in DFS. RT+XELOX seemed to have better effects on OS compared than RT+5-Fu and RT+CAPE (OR =0.78, 95% CrI: 0.61–1.00; OR =0.86, 95% CrI: 0.74–1.00, respectively). Moreover, according to surface under the cumulative ranking curve analysis, RT+XELOX had the best outcomes in terms of pCR (79.18%) and OS (83.49%) and RT plus capecitabine, irinotecan, and cetuximab (RT+XELIRI+CET) ranked first with respect to DFS (87.86%). CONCLUSIONS: RT+XELOX is likely to be the best treatment with a comprehensive curative effect and the standard treatment of 5-fluorouracil-based chemoradiotherapy has some advantages, as well. More relevant evidence is needed for clinicians’ guidance. AME Publishing Company 2020-08 /pmc/articles/PMC8798459/ /pubmed/35117848 http://dx.doi.org/10.21037/tcr-20-683 Text en 2020 Translational Cancer Research. All rights reserved. https://creativecommons.org/licenses/by-nc-nd/4.0/Open Access Statement: This is an Open Access article distributed in accordance with the Creative Commons Attribution-NonCommercial-NoDerivs 4.0 International License (CC BY-NC-ND 4.0), which permits the non-commercial replication and distribution of the article with the strict proviso that no changes or edits are made and the original work is properly cited (including links to both the formal publication through the relevant DOI and the license). See: https://creativecommons.org/licenses/by-nc-nd/4.0/. |
spellingShingle | Original Article Yu, Zhengyi Wang, Jiawei Xu, Lingyan Liu, Jin Chen, Xiaofeng Gu, Yanhong Comparison of different chemoradiotherapy regimens for the preoperative treatment in patients with locally advanced rectal cancer: a network meta-analysis |
title | Comparison of different chemoradiotherapy regimens for the preoperative treatment in patients with locally advanced rectal cancer: a network meta-analysis |
title_full | Comparison of different chemoradiotherapy regimens for the preoperative treatment in patients with locally advanced rectal cancer: a network meta-analysis |
title_fullStr | Comparison of different chemoradiotherapy regimens for the preoperative treatment in patients with locally advanced rectal cancer: a network meta-analysis |
title_full_unstemmed | Comparison of different chemoradiotherapy regimens for the preoperative treatment in patients with locally advanced rectal cancer: a network meta-analysis |
title_short | Comparison of different chemoradiotherapy regimens for the preoperative treatment in patients with locally advanced rectal cancer: a network meta-analysis |
title_sort | comparison of different chemoradiotherapy regimens for the preoperative treatment in patients with locally advanced rectal cancer: a network meta-analysis |
topic | Original Article |
url | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8798459/ https://www.ncbi.nlm.nih.gov/pubmed/35117848 http://dx.doi.org/10.21037/tcr-20-683 |
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