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Preoperative chemoradiation versus radiation alone for stage II and III resectable rectal cancer: a systematic review and meta-analysis

Wim Ceelen (UGent), KJELL FIERENS (UGent), Yves Van Nieuwenhove (UGent) and Piet Pattyn (UGent)
(2009) INTERNATIONAL JOURNAL OF CANCER. 124(12). p.2966-2972
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Abstract
Combining chemotherapy with preoperative radiotherapy (RT) has a sound radiobiological rationale. We performed a systematic review and meta-analysis of trials comparing preoperative RT with preoperative chemoradiation (CRT) in rectal cancer patients. The Cochrane Central Register of Controlled Trials, Web of Science, Embase and Medline (Pubmed) were searched from 1975 until June 2007. Dichotomous parameters were summarized using the odds ratio while time to event data were analyzed using the pooled hazard ratio for death. From the primary search result of 324 trials, 4 relevant randomized trials were identified. The addition of chemotherapy significantly increased grade III and IV acute toxicity (p = 0.002) while no differences were observed in postoperative morbidity or mortality. Preoperative CRT significantly increased the rate of pathological complete response (p < 0.001) although this did not translate into a higher sphincter preservation rate (p = 0.29). The local recurrence rate was significantly lower in the CRT group (p < 0.001). No statistically significant differences were observed in disease free survival (p = 0.89) or overall survival (p = 0.79). Compared to preoperative RT alone, preoperative CRT improves local control in rectal cancer but is associated with a more pronounced treatment related toxicity. The addition of chemotherapy does not benefit sphincter preservation rate or long-term survival. Future trials should address improvements in the rate of distant metastasis and overall survival by incorporating more active chemotherapy.
Keywords
LOCAL RECURRENCE, CARCINOMA, SURGERY, THERAPY, ANAL-SPHINCTER FUNCTION, TOTAL MESORECTAL EXCISION, SHORT-TERM RADIOTHERAPY, QUALITY-OF-LIFE, DOSE LEUCOVORIN, RANDOMIZED-TRIAL

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Chicago
Ceelen, Wim, KJELL FIERENS, Yves Van Nieuwenhove, and Piet Pattyn. 2009. “Preoperative Chemoradiation Versus Radiation Alone for Stage II and III Resectable Rectal Cancer: a Systematic Review and Meta-analysis.” International Journal of Cancer 124 (12): 2966–2972.
APA
Ceelen, Wim, FIERENS, K., Van Nieuwenhove, Y., & Pattyn, P. (2009). Preoperative chemoradiation versus radiation alone for stage II and III resectable rectal cancer: a systematic review and meta-analysis. INTERNATIONAL JOURNAL OF CANCER, 124(12), 2966–2972.
Vancouver
1.
Ceelen W, FIERENS K, Van Nieuwenhove Y, Pattyn P. Preoperative chemoradiation versus radiation alone for stage II and III resectable rectal cancer: a systematic review and meta-analysis. INTERNATIONAL JOURNAL OF CANCER. 2009;124(12):2966–72.
MLA
Ceelen, Wim, KJELL FIERENS, Yves Van Nieuwenhove, et al. “Preoperative Chemoradiation Versus Radiation Alone for Stage II and III Resectable Rectal Cancer: a Systematic Review and Meta-analysis.” INTERNATIONAL JOURNAL OF CANCER 124.12 (2009): 2966–2972. Print.
@article{906776,
  abstract     = {Combining chemotherapy with preoperative radiotherapy (RT) has a sound radiobiological rationale. We performed a systematic review and meta-analysis of trials comparing preoperative RT with preoperative chemoradiation (CRT) in rectal cancer patients. The Cochrane Central Register of Controlled Trials, Web of Science, Embase and Medline (Pubmed) were searched from 1975 until June 2007. Dichotomous parameters were summarized using the odds ratio while time to event data were analyzed using the pooled hazard ratio for death. From the primary search result of 324 trials, 4 relevant randomized trials were identified. The addition of chemotherapy significantly increased grade III and IV acute toxicity (p = 0.002) while no differences were observed in postoperative morbidity or mortality. Preoperative CRT significantly increased the rate of pathological complete response (p {\textlangle} 0.001) although this did not translate into a higher sphincter preservation rate (p = 0.29). The local recurrence rate was significantly lower in the CRT group (p {\textlangle} 0.001). No statistically significant differences were observed in disease free survival (p = 0.89) or overall survival (p = 0.79). Compared to preoperative RT alone, preoperative CRT improves local control in rectal cancer but is associated with a more pronounced treatment related toxicity. The addition of chemotherapy does not benefit sphincter preservation rate or long-term survival. Future trials should address improvements in the rate of distant metastasis and overall survival by incorporating more active chemotherapy.},
  author       = {Ceelen, Wim and FIERENS, KJELL and Van Nieuwenhove, Yves and Pattyn, Piet},
  issn         = {0020-7136},
  journal      = {INTERNATIONAL JOURNAL OF CANCER},
  keyword      = {LOCAL RECURRENCE,CARCINOMA,SURGERY,THERAPY,ANAL-SPHINCTER FUNCTION,TOTAL MESORECTAL EXCISION,SHORT-TERM RADIOTHERAPY,QUALITY-OF-LIFE,DOSE LEUCOVORIN,RANDOMIZED-TRIAL},
  language     = {eng},
  number       = {12},
  pages        = {2966--2972},
  title        = {Preoperative chemoradiation versus radiation alone for stage II and III resectable rectal cancer: a systematic review and meta-analysis},
  url          = {http://dx.doi.org/10.1002/ijc.24247},
  volume       = {124},
  year         = {2009},
}

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