Preoperative radiotherapy for resectable rectal cancer -: A meta-analysis
Preoperative radiotherapy for resectable rectal cancer -: A meta-analysis
复制标题
DOI：
10.1001/jama.284.8.1008
复制
发表时间：
2000-08-23
影响因子：
120.7
通讯作者：
Cottone, M
中科院分区：
文献类型：
--
作者：
Cammà, C;Giunta, M;Cottone, M
背景可切除直肠癌辅助放疗的益处已被广泛研究，目的评价术前放疗后手术治疗对降低术后复发率的有效性。相关死亡率和预防局部复发和远处转移。数据来源计算机检索MEDLINE和CANCERLIT（1970年至1999年12月），包括非英语来源，补充了手工搜索的参考清单。使用的医学主题词为直肠癌、放疗、手术、RCT、随机和临床试验，如果是比较术前放疗加手术与单纯手术的随机对照试验（RCT），并且如果纳入了组织学证实为可切除直肠腺癌且无转移性疾病的患者，则纳入研究选择研究。14个随机对照试验进行了分析。数据提取数据的人口，干预措施，和结果是从每个随机对照试验中提取的，根据意向治疗的方法，由3个独立的观察员，并结合使用DerSimonian和Laird方法。数据合成放射治疗加手术与单纯手术相比，显着降低了5年的总死亡率（比值比[OR] 0.84; 95%置信区间[CI] 0.72-0.98; P= 0.03），癌症相关死亡率（OR，0.71; 95% CI，0.61-0.82; P = 0.03），
Context The benefit of adjuvant radiotherapy for resectable rectal cancer has been extensively studied, but data on survival are still equivocal despite a reduction in the rate of local recurrence.Objective To assess the effectiveness of preoperative radiotherapy followed by surgery in the reduction of overall and cancer-related mortality and in the prevention of local recurrence and distant metastases.Data Sources Computerized bibliographic searches of MEDLINE and CANCERLIT (1970 to December 1999), including non-English sources, were supplemented with hand searches of reference lists. The medical subject headings used were rectal cancer, radiotherapy, surgery, RCT, randomized, and clinical trial,Study Selection Studies were included if they were randomized controlled trials (RCTs) comparing preoperative radiotherapy plus surgery with surgery alone and if they included patients with resectable histologically proven rectal adenocarcinoma, without metastatic disease. Fourteen RCTs were analyzed.Data Extraction Data on population, intervention, and outcomes were extracted from each RCT according to the intention-to-treat method by 3 independent observers and combined using the DerSimonian and Laird method.Data Synthesis Radiotherapy plus surgery compared with surgery alone significantly reduced the 5-year overall mortality rate (odds ratio [OR] 0.84; 95% confidence interval [CI], 0.72-0.98; P=.03), cancer-related mortality rate (OR, 0.71; 95% CI, 0.61-0.82; P