Neoadjuvant Radiotherapy for Rectal Cancer: Meta-analysis of Randomized Controlled Trials
Neoadjuvant Radiotherapy for Rectal Cancer: Meta-analysis of Randomized Controlled Trials
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DOI：
10.1245/s10434-013-3198-9
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发表时间：
2013-12-01
影响因子：
3.7
通讯作者：
Koch, Moritz
中科院分区：
文献类型：
--
作者：
Rahbari, Nuh N.;Elbers, Heike;Koch, Moritz
背景虽然新辅助放疗可以改善直肠癌的局部控制，但由于潜在的副作用和手术技术的进步，其临床价值需要进一步评估。本研究进行了一项荟萃分析，以评估新辅助放疗在直肠癌治疗中的有效性和安全性。检索了以下数据库：科克伦图书馆、Biosis、Web of Science、Embase、ASCO摘要和WHO国际临床试验注册平台。随机对照试验包括以下比较：（1）新辅助治疗与单纯手术;（2）新辅助放化疗与新辅助放疗。我们确定了17项和5项相关试验，分别招募了8，568名和2，393名患者。即使在全直肠系膜切除后，与单纯手术相比，新辅助放疗也能改善局部控制（风险比0.59; 95%置信区间0.48-0.72），而其总生存率的获益未能达到统计学显著性（0.93; 0.85-1.00）。然而，它与围手术期死亡率增加相关（1.48; 1.08-2.03），特别是如果每次给予5戈伊的剂量（1.85; 1.23-2.78）。与放疗相比，放化疗可改善局部控制（0.53; 0.39-0.72），对围手术期结局和长期生存率无影响。新辅助放疗可改善直肠癌患者的局部控制，特别是在进行放化疗时。使用更有效的化疗方案是否能提高总生存率的问题值得进一步研究。
Background. Although neoadjuvant radiotherapy may improve local control of rectal cancer, its clinical value requires further evaluation as a result of potential side effects and advances in surgical technique. A meta-analysis was performed to assess effectiveness and safety of neoadjuvant radiotherapy in the management of rectal cancer.Methods. The following databases were searched: the Cochrane Library, Biosis, Web of Science, Embase, ASCO Abstracts and WHO International Clinical Trials Registry Platform. Randomized controlled trials on the following comparisons were included: (1) neoadjuvant therapy versus surgery alone and (2) neoadjuvant chemoradiotherapy versus neoadjuvant radiotherapy.Results. We identified 17 and 5 relevant trials that enrolled 8,568 and 2,393 patients, respectively. Neoadjuvant radiotherapy improved local control (hazard ratio 0.59; 95 % confidence interval 0.48-0.72) compared to surgery alone even after total mesorectal excision, whereas its benefit in overall survival just failed to reach statistical significance (0.93; 0.85-1.00). However, it was associated with increased perioperative mortality (1.48; 1.08-2.03), in particular if a dose of 5 Gy per fraction was administered (1.85; 1.23-2.78). Chemoradiotherapy improved local control as opposed to radiotherapy (0.53; 0.39-0.72), with no impact on perioperative outcome and long-term survival.Conclusions. Neoadjuvant radiotherapy improves local control in patients with rectal cancer, particularly when chemoradiotherapy is administered. The question if the use of more effective chemotherapy protocols improves overall survival warrants further investigation.