Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
Meta-Analysis
. 2020 Oct;27(11):4319-4336.
doi: 10.1245/s10434-020-08615-2. Epub 2020 Jun 10.

Pathological Complete Response Following Different Neoadjuvant Treatment Strategies for Locally Advanced Rectal Cancer: A Systematic Review and Meta-analysis

S Hoendervangers  1   2 , J P M Burbach  3 , M M Lacle  4 , M Koopman  5 , W M U van Grevenstein  6 , M P W Intven  7 , H M Verkooijen  7
Affiliations
Meta-Analysis

Pathological Complete Response Following Different Neoadjuvant Treatment Strategies for Locally Advanced Rectal Cancer: A Systematic Review and Meta-analysis

S Hoendervangers et al. Ann Surg Oncol. 2020 Oct.

Abstract

Background: Pathological complete response (pCR) following neoadjuvant treatment for locally advanced rectal cancer (LARC) is associated with better survival, less local recurrence, and less distant failure. Furthermore, pCR indicates that the rectum may have been preserved. This meta-analysis gives an overview of available neoadjuvant treatment strategies for LARC and analyzes how these perform in achieving pCR as compared with the standard of care.

Methods: Pubmed, Embase, and Cochrane Central bibliographic databases were searched. Randomized controlled trials in which patients received neoadjuvant treatment for MRI-staged nonmetastatic resectable LARC were included. The primary outcome was pCR, defined as ypT0N0. A meta-analysis of studies comparing an intervention with standard fluoropyrimidine-based chemoradiation (CRT) was performed.

Results: Of the 17 articles included in the systematic review, 11 were used for the meta-analysis. Addition of oxaliplatin to fluoropyrimidine-based CRT resulted in significantly more pCR compared with fluoropyrimidine-based CRT only (OR 1.46), but at the expense of more ≥ grade 3 toxicity. Other treatment strategies, including consolidation/induction chemotherapy and short-course radiotherapy (SCRT), did not improve pCR rates. None of the included trials reported a benefit in local control or OS. Five-year DFS was significantly worse after SCRT-delay compared with CRT (59% vs. 75.1%, HR 1.93).

Conclusions: All included trials fail to deliver high-level evidence to show an improvement in pCR compared with standard fluoropyrimidine-based CRT. The addition of oxaliplatin might result in more pCR but at the expense of more toxicity. Furthermore, this benefit does not translate into less local recurrence or improved survival.

PubMed Disclaimer

Figures

Fig. 1
Fig. 1
PRISMA flowchart of included studies. Reasons for exclusion provided as Supplementary Data (available online)
Fig. 2
Fig. 2
Review authors’ judgements about each risk of bias item presented as percentages across all included studies: a risk of bias graph and b risk of bias summary
Fig. 3
Fig. 3
Pooled OR of pCR rates following multiagent chemoradiation, consolidation chemotherapy, and induction chemotherapy compared with standard fluoropyrimidine-based CRT
See this image and copyright information in PMC

References

    1. Glynne-Jones R, Wyrwicz L, Tiret E, et al. Rectal cancer: ESMO Clinical Practice Guidelines for diagnosis, treatment and follow-up. Ann Oncol. 2017;28(suppl_4):iv22–iv40. doi: 10.1093/annonc/mdx224. - DOI - PubMed
    1. Lutz MP, Zalcberg JR, Glynne-Jones R, et al. Second S.t Gallen European Organisation for research and treatment of cancer gastrointestinal cancer conference: consensus recommendations on controversial issues in the primary treatment of rectal cancer. Eur J Cancer. 2016;63:11–24. doi: 10.1016/j.ejca.2016.04.010. - DOI - PubMed
    1. Bosset JF, Collette L, Calais G, et al. Chemotherapy with preoperative radiotherapy in rectal cancer. N Eng J Med. 2006;355(11):1114–1123. doi: 10.1056/NEJMoa060829. - DOI - PubMed
    1. Nussbaum N, Altomare I. The neoadjuvant treatment of rectal cancer: a review. Curr Oncol Rep. 2015;17(3):434. doi: 10.1007/s11912-014-0434-9. - DOI - PubMed
    1. Zhao F, Wang J, Yu H, et al. Neoadjuvant radiotherapy improves overall survival for T3/4N + M0 rectal cancer patients: a population-based study of 20300 patients. Rad Oncol. 2020;15(1):49. doi: 10.1186/s13014-020-01497-4. - DOI - PMC - PubMed

MeSH terms