295 Radiotherapy for Curative-intent Metastatic Rectal Cancer: A Systematic Review and Meta-Analysis

2021 ◽  
Vol 108 (Supplement_2) ◽  
Author(s):  
K R Y Nistala ◽  
J W Yeo ◽  
Z G W Ow ◽  
C H Ng ◽  
J H Law ◽  
...  
Keyword(s):  
Rectal Cancer ◽  
Meta Analysis ◽  
Complete Response ◽  
Cochrane Library ◽  
Neoadjuvant Radiotherapy ◽  
Curative Intent ◽  
Treatment Regimens ◽  
Oncological Outcomes ◽  
Logarithmic Method ◽  
Long Course

Abstract Introduction The role and optimal regimen of radiotherapy in curative-intent treatment of metastatic rectal cancer is unclear and hence a single arm meta-analysis was performed. Method Medline, Embase and Cochrane Library databases were searched up to 16 May 2020. A Meta-analysis of binomial data was performed using a Freeman-Tukey double arcsine transformation, and pooled estimates were used to construct risk ratios and confidence intervals via the Katz-logarithmic method. Additionally, comparative meta-analysis was performed with the Mantel Haenszel model. Results 18 studies were included. Rectal pathological complete response (pCR) was observed in 14% of tumours treated with radiotherapy (n = 57/388, CI 0.07 to 0.23). Comparative meta-analysis of cohort studies showed that treatment regimens including radiotherapy were associated with higher pT1 tumour and better oncological outcomes compared to regimens without radiotherapy. Katz-logarithmic method showed that neoadjuvant radiotherapy had a higher proportion of pN0 staging (RR = 1.81, 95% CI 1.06 to 3.09, p = 0.029) and better oncological outcomes compared to adjuvant radiotherapy, and that short course radiotherapy (SCRT) had a lower proportion of pT3 tumours (RR = 0.778, 95% CI 0.609 to 0.994, p = 0.044) and similar oncological outcomes compared to long course radiotherapy (LCRT). Conclusions This study supports the evidence that radiotherapy should be used in curative intent metastatic rectal cancer.

scholarly journals Metformin With Neoadjuvant Chemoradiation to Improve Pathologic Response in Rectal Cancer: a Pilot Phase I/II Trial

2020 ◽  
Author(s):  
Shun Wong ◽  
William Chu ◽  
Shady Ashamalla ◽  
Darlene Fenech ◽  
Scott Berry ◽  
...  
Keyword(s):  
Rectal Cancer ◽  
Confidence Interval ◽  
Pathologic Complete Response ◽  
Complete Response ◽  
Neoadjuvant Chemoradiation ◽  
Diabetic Patients ◽  
Phase 2 ◽  
Neoadjuvant Radiotherapy ◽  
Phase 2 Trial ◽  
Long Course

Abstract Background: Neoadjuvant radiotherapy with or without chemotherapy decreases the risk of local recurrence after surgery for stage II or III rectal cancer. Emerging data suggest that diabetic patients on metformin may have improved cancer outcome after radiotherapy. We asked if metformin given concurrently with long course chemoradiation (CRT) may improve pathologic complete response (pCR) in non-diabetic rectal cancer patients. A single-institutional pilot study was performed to build a confidence interval for the pCR rate and to determine the sample size for a phase 2 trial.Methods: Non-diabetic patients with biopsy confirmed adenocarcinoma of the rectum, and deemed candidates for long course neoadjuvant CRT were invited to participate. Radiation consisted of 50.4 Gy in 28 daily fractions. Capecitabine (825 mg/m2 twice daily, Monday-Friday) was self-administered during the 28 days of radiation only. The primary outcome was pCR. The study was designed to accrue 15 participants to construct a confidence interval (CI) for the pCR rate. Results: A total of 16 patients were accrued from January 2017 to May 2018. One patient withdrew from the study prior to CRT. Only grade 1 or 2 adverse events were observed from the intervention. Three patients had a clinical complete response (cCR) and did not have surgical resection. Of the 12 patients who underwent surgery, there were two pCRs. For the combined pCR/cCR rate of 33% (95% CI 19-47%), a total of 85 patients will be required to yield a 95% CI with a 10% margin of error. Conclusions: Adding metformin to neoadjuvant CRT for rectal cancer does not appear to enhance toxicities. These results will be used to refine the design and conduct of a future phase 2 trial to determine whether adding metformin to CRT improves pCR/cCR rates. Trial registration: NCT03053544. Registered December 20, 2016, https://clinicaltrials.gov/ct2/show/record/NCT03053544

scholarly journals Prognosis comparison between wait and watch and surgical strategy on rectal cancer patients after treatment with neoadjuvant chemoradiotherapy: a meta-analysis

2019 ◽  
Vol 12 ◽  
pp. 175628481989247 ◽  
Author(s):  
Kai Pang ◽  
Quan Rao ◽  
Shengqi Qin ◽  
Lan Jin ◽  
Hongwei Yao ◽  
...  
Keyword(s):  
Rectal Cancer ◽  
Surgical Treatment ◽  
Cancer Patients ◽  
Distant Metastasis ◽  
Meta Analysis ◽  
Neoadjuvant Chemoradiotherapy ◽  
Complete Response ◽  
Prognostic Indicators ◽  
Cochrane Library ◽  
Surgery Group

Background: After achieving a clinical complete response through neoadjuvant chemoradiotherapy, a nonoperative management approach for rectal cancer patients known as Wait and Watch (W&W) has gained increasing attention. However, the W&W strategy has been related to higher local recurrence and ambiguous long-term survival. This meta-analysis compared key prognosis indicators between W&W and surgical treatment in an effort to clarify some long-standing points of confusion. Methods: Pubmed, Web of Science, EMbase, Cochrane Library were searched for relevant researches comparing W&W with surgery treatment, with a time criteria set from 1 January 2002 to 4 July 2019. Endpoints were 2-year local regrowth/recurrence, 2-year distant metastasis (plus local regrowth/recurrence), 3- and 5-year disease-free survival (DFS), and overall survival (OS). Results: In total, nine studies with 801 patients were enrolled, of which 348 were managed by W&W and 453 by surgery. Surgery patients were further divided into a pathological complete response (pCR) group (all included patients achieved pCR) and a surgery group (consisting of both pCR and non-pCR patients without deliberate screening). Compared with the surgery group, W&W patients have higher 3- and 5-year OS, and are not inferior on 2-year local regrowth (LR), 2-year distant metastasis (DM)/DM+LR, and 3- and 5-year DFS. On the other hand, compared with the pCR group, the W&W group is inferior on 2-year LR, 3- and 5-year DFS, and 5-year OS, and not inferior on 2-year DM/DM+LR and 3-year OS. Conclusions: In contrast with patients undergoing surgical treatment, the W&W group has higher 3- and 5-year OS, and is not inferior on other major prognostic indicators, which, however, is based on the fact that the tumor stage in the W&W group is generally earlier. Versus surgically treated patients who acquired pCR, W&W group is inferior on all major prognostic indicators except 2-year DM/DM+LR and 3-year OS. Additionally, by comparison of cCR definitions across different studies, we conclude that implementation of the strictest cCR criteria is critical for W&W patients to acquire maximum prognostic benefit.

scholarly journals Re-Irradiation in Patients with Recurrent Rectal Cancer is Safe and Feasible

2021 ◽  
Author(s):  
Esmée A. Dijkstra ◽  
Véronique E. M. Mul ◽  
Patrick H. J. Hemmer ◽  
Klaas Havenga ◽  
Geke A. P. Hospers ◽  
...  
Keyword(s):  
Rectal Cancer ◽  
Locally Advanced ◽  
Disease Free Survival ◽  
Late Toxicity ◽  
Skin Toxicity ◽  
Complete Response ◽  
Recurrent Rectal Cancer ◽  
Free Survival ◽  
Oncological Outcomes ◽  
Long Course

Abstract Background There is no consensus yet for the best treatment regimen in patients with recurrent rectal cancer (RRC). This study aims to evaluate toxicity and oncological outcomes after re-irradiation in patients with RRC in our center. Clinical (cCR) and pathological complete response (pCR) rates and radicality were also studied. Methods Between January 2010 and December 2018, 61 locally advanced RRC patients were treated and analyzed retrospectively. Patients received radiotherapy at a dose of 30.0–30.6 Gy (reCRT) or 50.0–50.4 Gy chemoradiotherapy (CRT) in cases of no prior irradiation because of low-risk primary rectal cancer. In both groups, patients received capecitabine concomitantly. Results In total, 60 patients received the prescribed neoadjuvant (chemo)radiotherapy followed by surgery, 35 patients (58.3%) in the reRCT group and 25 patients (41.7%) in the long-course CRT group. There were no significant differences in overall survival (p = 0.82), disease-free survival (p = 0.63), and local recurrence-free survival (p = 0.17) between the groups. Patients in the long-course CRT group reported more skin toxicity after radiotherapy (p = 0.040). No differences were observed in late toxicity. In the long-course CRT group, a significantly higher cCR rate was observed (p = 0.029); however, there was no difference in the pCR rate (p = 0.66). Conclusions The treatment of RRC patients with re-irradiation is comparable to treatment with long-course CRT regarding toxicity and oncological outcomes. In the reCRT group, less cCR was observed, although there was no difference in pCR. The findings in this study suggest that it is safe and feasible to re-irradiate RRC patients.

scholarly journals Effects of Neoadjuvant Radiotherapy on Postoperative Complications in Rectal Cancer: A Meta-Analysis

2022 ◽  
Vol 2022 ◽  
pp. 1-16
Author(s):  
Jianguo Yang ◽  
Yajun Luo ◽  
Tingting Tian ◽  
Peng Dong ◽  
Zhongxue Fu
Keyword(s):  
Rectal Cancer ◽  
Postoperative Complications ◽  
Wound Infection ◽  
Meta Analysis ◽  
Pelvic Abscess ◽  
Neoadjuvant Radiotherapy ◽  
Pooled Data ◽  
Short Course ◽  
Long Course ◽  
The Relationship

Objective. Neoadjuvant radiotherapy (nRT) is an important treatment approach for rectal cancer. The relationship, however, between nRT and postoperative complications is still controversial. Here, we conducted a meta-analysis to evaluate such concerns. Methods. The electronic literature from 1983 to 2021 was searched in PubMed, Embase, and Web of Science. Postoperative complications after nRT were included in the meta-analysis. The pooled odds ratio (OR) was calculated by the random-effects model. Statistical analysis was conducted by Review Manager 5.3 and STATA 14. Results. A total of 23,723 patients from 49 studies were included in the meta-analysis. The pooled results showed that nRT increased the risk of anastomotic leakage (AL) compared to upfront surgery (OR = 1.23; 95% CI, 1.07–1.41; p = 0.004 ). Subgroup analysis suggested that both long-course (OR = 1.20, 95% CI 1.03–1.40; p = 0.02 ) and short-course radiotherapy (OR = 1.25, 95% CI, 1.02–1.53; p = 0.04 ) increased the incidence of AL. In addition, nRT was the main risk factor for wound infection and pelvic abscess. The pooled data in randomized controlled trials, however, indicated that nRT was not associated with AL (OR = 1.01; 95% CI 0.82–1.26; p = 0.91 ). Conclusions. nRT may increase the risk of AL, wound infection, and pelvic abscess compared to upfront surgery among patients with rectal cancer.

Intersphincteric Resection Versus Abdominoperineal Resection for Low Rectal Cancer: A Meta-Analysis

2020 ◽  
pp. 155335062091841
Author(s):  
Baifu Peng ◽  
Jiabao Lu ◽  
Zixin Wu ◽  
Guanwei Li ◽  
Fang Wei ◽  
...  
Keyword(s):  
Rectal Cancer ◽  
Abdominoperineal Resection ◽  
Postoperative Morbidity ◽  
Meta Analysis ◽  
Intersphincteric Resection ◽  
Low Rectal Cancer ◽  
Cochrane Library ◽  
Safe Alternative ◽  
Permanent Colostomy ◽  
Oncological Outcomes

Background. Abdominoperineal resection (APR) has been the standard surgery for ultra-low rectal cancer for a century. In recent years, intersphincteric resection (ISR) has been increasingly used to avoid the permanent colostomy. Up to now, there is no relevant meta-analysis comparing the clinical efficacy of ISR and APR. This meta-analysis aimed to compare the outcomes of these 2 procedures. Methods. A comprehensive search of online databases was performed on PubMed, EMBASE, and the Cochrane Library to obtain comparative studies of ISR and APR. Then the data from studies that met the inclusion criteria were extracted and analyzed. Results. A total of 12 studies covering 2438 patients were included. No significant differences were found between ISR and APR in gender, body mass index, distance from tumor to anal edge, operative time, and blood loss. In addition, hospital stay (weighted mean differences = −2.98 days; 95% confidence interval [CI] = −3.54 to −2.43; P < .00001) and postoperative morbidity (odds ratio [OR] = 0.76; 95% CI = 0.59 to 0.99; P = .04) were significantly lower in ISR group compared with APR group. However, patients who underwent ISR showed lower pathological T-stage (T3T4%, OR = 0.49; 95% CI = 0.28 to 0.86; P = .01) and lymph node metastasis rate (OR = 0.77; 95% CI = 0.59 to 1.01; P = .06) compared with those who underwent APR. Moreover, oncological outcomes were similar between the 2 groups. Conclusion. ISR may provide a safe alternative to APR, with shorter hospital stays, lower postoperative morbidity, and similar oncological outcomes. Well-designed randomized controlled trials are needed to confirm and update the findings of this analysis.

scholarly journals Effect of Interval between Neoadjuvant Chemoradiotherapy and Surgery on Oncological Outcome for Rectal Cancer: A Systematic Review and Meta-Analysis

2016 ◽  
Vol 2016 ◽  
pp. 1-13 ◽  
Author(s):  
Xiao-Jie Wang ◽  
Zheng-Rong Zheng ◽  
Pan Chi ◽  
Hui-Ming Lin ◽  
Xing-Rong Lu ◽  
...  
Keyword(s):  
Rectal Cancer ◽  
Meta Analysis ◽  
Neoadjuvant Chemoradiotherapy ◽  
Oncological Outcome ◽  
Complete Response ◽  
Cochrane Library ◽  
Rectal Cancer Surgery ◽  
Inclusion Criteria ◽  
Retrospective Cohort Studies ◽  
The Cochrane Library

Aim. To evaluate the influence of interval between neoadjuvant chemoradiotherapy (NCRT) and surgery on oncological outcome.Methods. A systematic search was conducted in PubMed, the Cochrane Library, and Embase databases for publications reporting oncological outcomes of patients following rectal cancer surgery performed at different NCRT-surgery intervals. Relative risk (RR) of pathological complete response (pCR) among different intervals was pooled.Results. Fifteen retrospective cohort studies representing 4431 patients met the inclusion criteria. There was a significantly increased rate of pCR in patients treated with surgery followed 7 or 8 weeks later (RR, 1.45; 95% CI, 1.18–1.78; andP<0.01and RR, 1.49; 95% CI, 1.15–1.92; andP=0.002, resp.). There is no consistent evidence of improved local control or overall survival with longer or shorter intervals.Conclusion. Performing surgery 7-8 weeks after the end of NCRT results in the highest chance of achieving pCR. For candidates of abdominoperineal resection before NCRT, these data support implementation of prolonging the interval after NCRT to optimize the chances of pCR and perhaps add to the possibility of ultimate organ preservation.

scholarly journals Long-term oncologic outcomes of transanal TME compared with transabdominal TME for rectal cancer: a systematic review and meta-analysis

2021 ◽  
Author(s):  
Jae Young Moon ◽  
Min Ro Lee ◽  
Gi Won Ha
Keyword(s):  
Rectal Cancer ◽  
Meta Analysis ◽  
Disease Free Survival ◽  
Distant Recurrence ◽  
Oncologic Outcomes ◽  
Cochrane Library ◽  
Transanal Total Mesorectal Excision ◽  
Random Effects Models ◽  
The Cochrane Library

Abstract Background Transanal total mesorectal excision (TaTME) appears to have favorable surgical and pathological outcomes. However, the evidence on survival outcomes remains unclear. We performed a meta-analysis to compare long-term oncologic outcomes of TaTME with transabdominal TME for rectal cancer. Methods PubMed, EMBASE, and the Cochrane Library were searched. Data were pooled, and overall effect size was calculated using random-effects models. Outcome measures were overall survival (OS), disease-free survival (DFS), and local and distant recurrence. Results We included 11 nonrandomized studies that examined 2,143 patients for the meta-analysis. There were no significant differences between the two groups in OS, DFS, and local and distant recurrence with a RR of 0.65 (95% CI 0.39–1.09, I2 = 0%), 0.79 (95% CI 0.57–1.10, I2 = 0%), 1.14 (95% CI 0.44–2.91, I2 = 66%), and 0.75 (95% CI 0.40–1.41, I2 = 0%), respectively. Conclusion In terms of long-term oncologic outcomes, TaTME may be an alternative to transabdominal TME in patients with rectal cancer. Well-designed randomized trials are warranted to further verify these results.

scholarly journals Adjuvant Transarterial Chemoembolization Following Curative-Intent Hepatectomy Versus Hepatectomy Alone for Hepatocellular Carcinoma: A Systematic Review and Meta-Analysis of Randomized Controlled Trials

Cancers ◽  
2021 ◽  
Vol 13 (12) ◽  
pp. 2984
Author(s):  
Stepan M. Esagian ◽  
Christos D. Kakos ◽  
Emmanouil Giorgakis ◽  
Lyle Burdine ◽  
J. Camilo Barreto ◽  
...  
Keyword(s):  
Hepatocellular Carcinoma ◽  
Systematic Review ◽  
Randomized Controlled Trials ◽  
Transarterial Chemoembolization ◽  
Meta Analysis ◽  
Risk Of Bias ◽  
Cochrane Library ◽  
Controlled Trials ◽  
Curative Intent ◽  
Randomized Controlled

The role of adjuvant transarterial chemoembolization (TACE) for patients with resectable hepatocellular carcinoma (HCC) undergoing hepatectomy is currently unclear. We performed a systematic review of the literature using the MEDLINE, Embase, and Cochrane Library databases. Random-effects meta-analysis was carried out to compare the overall survival (OS) and recurrence-free survival (RFS) of patients with resectable HCC undergoing hepatectomy followed by adjuvant TACE vs. hepatectomy alone in randomized controlled trials (RCTs). The risk of bias was assessed using the Risk of Bias 2.0 tool. Meta-regression analyses were performed to explore the effect of hepatitis B viral status, microvascular invasion, type of resection (anatomic vs. parenchymal-sparing), and tumor size on the outcomes. Ten eligible RCTs, reporting on 1216 patients in total, were identified. The combination of hepatectomy and adjuvant TACE was associated with superior OS (hazard ratio (HR): 0.66, 95% confidence interval (CI): 0.52 to 0.85; p < 0.001) and RFS (HR: 0.70, 95% CI: 0.56 to 0.88; p < 0.001) compared to hepatectomy alone. There were significant concerns regarding the risk of bias in most of the included studies. Overall, adjuvant TACE may be associated with an oncologic benefit in select HCC patients. However, the applicability of these findings may be limited to Eastern Asian populations, due to the geographically restricted sample. High-quality multinational RCTs, as well as predictive tools to optimize patient selection, are necessary before adjuvant TACE can be routinely implemented into standard practice. PROSPERO Registration ID: CRD42021245758.

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