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Preoperative chemoradiotherapy versus postoperative chemoradiotherapy for stage II–III resectable rectal cancer: a meta-analysis of randomized controlled trials
Radiation Oncology Journal ; : 198-207, 2017.
Artículo en Inglés | WPRIM | ID: wpr-144726
ABSTRACT

PURPOSE:

Whether preoperative chemoradiotherapy (CRT) is better than postoperative CRT in oncologic outcome and toxicity is contentious in prospective randomized clinical trials. We systematically analyze and compare the treatment result, toxicity, and sphincter preservation rate between preoperative CRT and postoperative CRT in stage II–III rectal cancer. MATERIALS AND

METHODS:

We searched Medline, Embase, and Cochrane Library from 1990 to 2014 for relevant trials. Only phase III randomized studies performing CRT and curative surgery were selected and the data were extracted. Meta-analysis was used to pool oncologic outcome and toxicity data across studies.

RESULTS:

Three randomized phase III trials were finally identified. The meta-analysis results showed significantly lower 5-year locoregional recurrence rate in the preoperative-CRT group than in the postoperative-CRT group (hazard ratio, 0.59; 95% confidence interval, 0.41–0.84; p = 0.004). The 5-year distant recurrence rate (p = 0.55), relapse-free survival (p = 0.14), and overall survival (p = 0.22) showed no significant difference between two groups. Acute toxicity was significantly lower in the preoperativeCRT group than in the postoperative-CRT group (p < 0.001). However, there was no significant difference between two groups in perioperative and chronic complications (p = 0.53). The sphincter-saving rate was not significantly different between two groups (p = 0.24). The conversion rate from abdominoperineal resection to low anterior resection in low rectal cancer was significantly higher in the preoperative-CRT group than in the postoperative-CRT group (p < 0.001).

CONCLUSIONS:

As compared to postoperative CRT, preoperative CRT improves only locoregional control, not distant control and survival, with similar chronic toxicity and sphincter preservation rate in rectal cancer patients.
Asunto(s)

Texto completo: Disponible Índice: WPRIM (Pacífico Occidental) Asunto principal: Neoplasias del Recto / Recurrencia / Estudios Prospectivos / Quimioradioterapia Tipo de estudio: Ensayo Clínico Controlado / Estudio observacional / Revisiones Sistemáticas Evaluadas Límite: Humanos Idioma: Inglés Revista: Radiation Oncology Journal Año: 2017 Tipo del documento: Artículo

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Texto completo: Disponible Índice: WPRIM (Pacífico Occidental) Asunto principal: Neoplasias del Recto / Recurrencia / Estudios Prospectivos / Quimioradioterapia Tipo de estudio: Ensayo Clínico Controlado / Estudio observacional / Revisiones Sistemáticas Evaluadas Límite: Humanos Idioma: Inglés Revista: Radiation Oncology Journal Año: 2017 Tipo del documento: Artículo