Año 2019 / Volumen 111 / Número 1
Original
Comparison of long course and short course preoperative radiotherapy in the treatment of locally advanced rectal cancer: a systematic review and meta-analysis

17-27

DOI: 10.17235/reed.2018.5674/2018

Yongjun Yu, Yuwei Li, Chen Xu, Zhao Zhang, Xipeng Zhang,

Resumen
Background: rectal cancer (RC) is one of the most prevalent malignancies worldwide and different preoperative radiotherapies may lead to different outcomes. This meta-analysis aimed to compare the effectiveness of long-course (LC) and short-course radiotherapy (SC), with or without chemotherapy, for locally advanced rectal cancer. Methods: studies published up to March 31st 2018 were retrieved from PubMed, Medline, Cochrane and EMABSE. Randomized control or consort control trials that reported the outcomes of short or long course radiotherapy were eligible. Either a fixed or random effects model was used to access the overall combined risk estimates. Results: sixteen studies with a total of 2,773 RC patients were included in the analysis. There were no significant differences between LC and SC therapies with regard to the following: pathological complete response (PCR) (I2 = 78%, p < 0.05, RR = 0.54, 95% CI: 0.26-1.10); tumor downstaging (I2 = 79%, p < 0.05, RR = 0.83, 95% CI: 0.58-1.17); local recurrences (I2 = 22%, p = 0.27, RR = 0.55, 95% CI: 0.26-1.16); distant metastases (I2 = 29%, p = 0.22, RR = 1.03, 95% CI: 0.77-1.37); mortality (I2 = 0%, p = 0.78, RR = 0.95, 95% CI: 0.78-1.15) and serious late toxicity (I2 = 74%, p = 0.01, RR = 1.10, 95% CI: 0.37-3.26). In the subgroup analysis, LC had a better PCR and tumor downstaging rate compared with SC in the RCT subgroup. Besides, LC also presented a better PCR rate compared with SC without chemotherapy. Conclusions: LC and SC are both effective in the preoperative treatment of RC with regard to PCR, tumor downstaging, local recurrences, distant metastases, mortality and serious late toxicity. Furthermore, chemotherapy may enhance the efficacy of preoperative treatment.
Share Button
Nuevo comentario
Comentarios
No hay comentarios para este artículo.
Bibliografía
1. Aran V, Victorino AP, Thuler LC, et al. Colorectal Cancer: Epidemiology, Disease Mechanisms and Interventions to Reduce Onset and Mortality. Clin Colorectal Canc 2016;15(3):195-203.
2. Kolligs FT. Diagnostics and Epidemiology of Colorectal Cancer. Visc Med 2016;32(3):158.
3. Sauer R, Becker H, Hohenberger W, et al. Preoperative versus postoperative chemoradiotherapy for rectal cancer. N Engl J Med 2004;351(17):1731-40.
4. Siegel R, Burock S, Wernecke KD, et al. Preoperative short-course radiotherapy versus combined radiochemotherapy in locally advanced rectal cancer: a multi-centre prospectively randomised study of the Berlin Cancer Society. BMC Cancer 2009;9(1):50-.
5. Bujko K, Nowacki MP, Nasierowskaguttmejer A, et al. Sphincter preservation following preoperative radiotherapy for rectal cancer: report of a randomised trial comparing short-term radiotherapy vs. conventionally fractionated radiochemotherapy. Radiother Oncol 2004;72(1):15-24.
6. Gerard JP, Chapet O, Nemoz C, et al. Improved sphincter preservation in low rectal cancer with high-dose preoperative radiotherapy: the lyon R96-02 randomized trial. International Journal of Radiation Oncology, Biology, Physics 2003;57(2):S179-S80.
7. Listed N. Initial report from a Swedish multicentre study examining the role of preoperative irradiation in the treatment of patients with resectable rectal carcinoma. Br J Surg 2010;80(10):1333-6.
8. Marijnen CAM, Kapiteijn E, Velde CJHVD, et al. Acute Side Effects and Complications After Short-Term Preoperative Radiotherapy Combined With Total Mesorectal Excision in Primary Rectal Cancer: Report of a Multicenter Randomized Trial. J Clin Oncol 2002;20(3):817-25.
9. Bujko K, Nowacki MP, Nasierowska-Guttmejer A, et al. Long-term results of a randomized trial comparing preoperative short-course radiotherapy with preoperative conventionally fractionated chemoradiation for rectal cancer. Br J Surg 2006;93(10):1215-23.
10. Skóra T, Nowaksadzikowska J, Martynów D, et al. Preoperative short-course radiotherapy in rectal cancer patients: results and prognostic factors. J Radiat Oncol 2018;7(1):77-84.
11. Mi JC, Dong WK, Chung WK, et al. Preoperative short- vs. long-course chemoradiotherapy with delayed surgery for locally advanced rectal cancer. Oncotarget 2016;8(36):60479-86.
12. Eitta MA, El-Wahidi GF, Fouda MA, et al. Preoperative radiotherapy in resectable rectal cancer: a prospective randomized study of two different approaches. J Egypt Natl Canc Inst 2010;22(3):155-64.
13. Kairevičė L, Latkauskas T, Tamelis A, et al. Preoperative long-course chemoradiotherapy plus adjuvant chemotherapy versus short-course radiotherapy without adjuvant chemotherapy both with delayed surgery for stage II-III resectable rectal cancer: 5-Year survival data of a randomized controlled trial. Medicina 2017.
14. Krajcovicova I, Bolješíková E, Sandorova M, et al. Preoperative radiotherapy of locally advanced rectal cancer: clinical outcome of short-course and long-course treatment with or without concomitant chemotherapy. Klin Onkol 2012;25(5):364.
15. Latkauskas T, Pauzas H, Gineikiene I, et al. Initial results of a randomized controlled trial comparing clinical and pathological downstaging of rectal cancer after preoperative short‐course radiotherapy or long‐term chemoradiotherapy, both with delayed surgery. Colorectal Dis 2012;14(3):294-8.
16. Lee SW, Lee JH, Lee IK, et al. The Impact of Surgical Timing on Pathologic Tumor Response after Short Course and Long Course Preoperative Chemoradiation for Locally Advanced Rectal Adenocarcinoma. Cancer Res Treat 2017;45(2):781-91.
17. Markovina S, Youssef F, Roy A, et al. Improved Metastasis- and Disease-Free Survival With Preoperative Sequential Short-Course Radiation Therapy and FOLFOX Chemotherapy for Rectal Cancer Compared With Neoadjuvant Long-Course Chemoradiotherapy: Results of a Matched Pair Analysis. Int J Radiat Oncol Biol Phys 2017;99(2):417-26.
18. Read TE, Mcnevin MS, Gross EK, et al. Neoadjuvant therapy for adenocarcinoma of the rectum: tumor response and acute toxicity. Dis Colon Rectum 2001;44(4):513-22.
19. Ngan SY, Burmeister B, Fisher RJ, et al. Randomized trial of short-course radiotherapy versus long-course chemoradiation comparing rates of local recurrence in patients with T3 rectal cancer: Trans-Tasman Radiation Oncology Group Trial 01.04. J Clin Oncol 2012;30(31):3827-33.
20. Vironen J, Juhola M, Kairaluoma M, et al. Tumour regression grading in the evaluation of tumour response after different preoperative radiotherapy treatments for rectal carcinoma. Int J Colorectal Dis 2005;20(5):440-5.
21. Yeh CH, Chen MF, Lai CH, et al. Comparison of treatment results between surgery alone, preoperative short-course radiotherapy, or long-course concurrent chemoradiotherapy in locally advanced rectal cancer. Int J Clin Oncol 2012;17(5):482-90.
22. Ansari N, Solomon MJ, Fisher RJ, et al. Acute Adverse Events and Postoperative Complications in a Randomized Trial of Preoperative Short-course Radiotherapy Versus Long-course Chemoradiotherapy for T3 Adenocarcinoma of the Rectum: Trans-Tasman Radiation Oncology Group Trial (TROG 01.04). Ann Surg 2017;265(5):882.
23. Guckenberger M, Wehner D, Sweeney RA, et al. Comparison of preoperative short-course radiotherapy and long-course radiochemotherapy for locally advanced rectal cancer. Strahlenther Onkol 2012;188(7):551-7.
24. Pettersson D, Cedermark B, Holm T, et al. Interim analysis of the Stockholm III trial of preoperative radiotherapy regimens for rectal cancer. BJS 2010;97(4):580–7.
25. Zhou ZR, Liu SX, Zhang TS, et al. Short-course preoperative radiotherapy with immediate surgery versus long-course chemoradiation with delayed surgery in the treatment of rectal cancer: a systematic review and meta-analysis. Surgical oncology 2014;23(4):211-21.
26. Birgisson H, Pã¥Hlman L, Gunnarsson U, et al. Adverse effects of preoperative radiation therapy for rectal cancer: long-term follow-up of the Swedish Rectal Cancer Trial. J Clin Oncol 2005;23(34):8697-705.
27. Pettersson D, Holm T, Iversen H, et al. Preoperative short-course radiotherapy with delayed surgery in primary rectal cancer. Br J Surg 2012;99(4):577-83.
28. Hartley A, Giridharan S, Srihari N, et al. Impaired postoperative neutrophil leucocytosis and acute complications following short course preoperative radiotherapy for operable rectal cancer. Eur J Surg Oncol 2003;29(2):155-7.
29. Julianov A. Retrospective study of acute toxicity following short-course preoperative radiotherapy. Br J Surg 2002;89(7):889.
30. Bosset JF, Calais G, Mineur L, et al. Preoperative radiation (Preop RT) in rectal cancer: Effect and timing of additional chemotherapy (CT) 5-year results of the EORTC 22921 trial. J Clin Oncol 2005;23(16):247S.
31. Gérard JP, Conroy T, Bonnetain F, et al. Preoperative radiotherapy with or without concurrent fluorouracil and leucovorin in T3-4 rectal cancers: results of FFCD 9203. J Clin Oncol 2006;24(28):4620-5.
32. Bosset JF, Collette L, Calais G, et al. Chemotherapy with preoperative radiotherapy in rectal cancer. N Engl J Med 2006;355(11):1114-23.
33. S. BOULIS-WASSIF FAG, J. LOYGUE, D. CAMELOT, M. BUYSE, N. DUEZlI. Final Results of a Randomized Trial on the Treatment of Rectal Cancer With Preoperative Radiotherapy Alone or in Combination With 5-Fluorouracil, Followed by Radical Surgery. Trial of the European Organization on Research and Treatment of Cancer Gastrointestinal Tract Cancer Cooperative Group. Cancer;53:1811-8.
1. Aran V, Victorino AP, Thuler LC, et al. Colorectal Cancer: Epidemiology, Disease Mechanisms and Interventions to Reduce Onset and Mortality. Clin Colorectal Canc 2016;15(3):195-203.
2. Kolligs FT. Diagnostics and Epidemiology of Colorectal Cancer. Visc Med 2016;32(3):158.
3. Hartley A, Giridharan S, Srihari N, et al. Impaired postoperative neutrophil leucocytosis and acute complications following short course preoperative radiotherapy for operable rectal cancer. Eur J Surg Oncol 2003;29(2):155-7.
4. Kapiteijn E, Marijnen CA, Nagtegaal ID, et al. Preoperative radiotherapy combined with total mesorectal excision for resectable rectal cancer. Ritorno Al Numero 2001;177(12):682.
5. Sebag-Montefiore D, Stephens RJ, Steele R, et al. Preoperative radiotherapy versus selective postoperative chemoradiotherapy in patients with rectal cancer (MRC CR07 and NCIC-CTG C016): a multicentre, randomised trial. Lancet 2009;373(9666):811.
6. Bosset JF, Collette L, Calais G, et al. Chemotherapy with preoperative radiotherapy in rectal cancer. N Engl J Med 2006;355(11):1114-23.
7. Siegel R, Burock S, Wernecke KD, et al. Preoperative short-course radiotherapy versus combined radiochemotherapy in locally advanced rectal cancer: a multi-centre prospectively randomised study of the Berlin Cancer Society. BMC Cancer 2009;9(1):50-.
8. Sauer R, Becker H, Hohenberger W, et al. Preoperative versus postoperative chemoradiotherapy for rectal cancer. N Engl J Med 2004;351(17):1731-40.
9. Bujko K, Nowacki MP, Nasierowskaguttmejer A, et al. Sphincter preservation following preoperative radiotherapy for rectal cancer: report of a randomised trial comparing short-term radiotherapy vs. conventionally fractionated radiochemotherapy. Radiother Oncol 2004;72(1):15-24.
10. Gerard JP, Chapet O, Nemoz C, et al. Improved sphincter preservation in low rectal cancer with high-dose preoperative radiotherapy: the lyon R96-02 randomized trial. Int J Radiat Oncol 2003;57(2):S179-S80.
11. Listed N. Initial report from a Swedish multicentre study examining the role of preoperative irradiation in the treatment of patients with resectable rectal carcinoma. Br J Surg 2010;80(10):1333-6.
12. Marijnen CAM, Kapiteijn E, Velde CJHVD, et al. Acute Side Effects and Complications After Short-Term Preoperative Radiotherapy Combined With Total Mesorectal Excision in Primary Rectal Cancer: Report of a Multicenter Randomized Trial. J Clin Oncol 2002;20(3):817-25.
13. Bujko K, Nowacki MP, Nasierowska-Guttmejer A, et al. Long-term results of a randomized trial comparing preoperative short-course radiotherapy with preoperative conventionally fractionated chemoradiation for rectal cancer. Br J Surg 2006;93(10):1215-23.
14. Skóra T, Nowaksadzikowska J, Martynów D, et al. Preoperative short-course radiotherapy in rectal cancer patients: results and prognostic factors. J Radiat Oncol 2018;7(1):77-84.
15. Mi JC, Dong WK, Chung WK, et al. Preoperative short- vs. long-course chemoradiotherapy with delayed surgery for locally advanced rectal cancer. Oncotarget 2016;8(36):60479-86.
16. Eitta MA, El-Wahidi GF, Fouda MA, et al. Preoperative radiotherapy in resectable rectal cancer: a prospective randomized study of two different approaches. J Egypt Natl Canc Inst 2010;22(3):155-64.
17. Kairevičė L, Latkauskas T, Tamelis A, et al. Preoperative long-course chemoradiotherapy plus adjuvant chemotherapy versus short-course radiotherapy without adjuvant chemotherapy both with delayed surgery for stage II-III resectable rectal cancer: 5-Year survival data of a randomized controlled trial. Medicina 2017.
18. Krajcovicova I, Bolješíková E, Sandorova M, et al. Preoperative radiotherapy of locally advanced rectal cancer: clinical outcome of short-course and long-course treatment with or without concomitant chemotherapy. Klin Onkol 2012;25(5):364.
19. Latkauskas T, Pauzas H, Gineikiene I, et al. Initial results of a randomized controlled trial comparing clinical and pathological downstaging of rectal cancer after preoperative short‐course radiotherapy or long‐term chemoradiotherapy, both with delayed surgery. Colorectal Dis 2012;14(3):294-8.
20. Lee SW, Lee JH, Lee IK, et al. The Impact of Surgical Timing on Pathologic Tumor Response after Short Course and Long Course Preoperative Chemoradiation for Locally Advanced Rectal Adenocarcinoma. Cancer Res Treat 2017;45(2):781-91.
21. Markovina S, Youssef F, Roy A, et al. Improved Metastasis- and Disease-Free Survival With Preoperative Sequential Short-Course Radiation Therapy and FOLFOX Chemotherapy for Rectal Cancer Compared With Neoadjuvant Long-Course Chemoradiotherapy: Results of a Matched Pair Analysis. Int J Radiat Oncol Biol Phys 2017;99(2):417-26.
22. Read TE, Mcnevin MS, Gross EK, et al. Neoadjuvant therapy for adenocarcinoma of the rectum: tumor response and acute toxicity. Dis Colon Rectum 2001;44(4):513-22.
23. Ngan SY, Burmeister B, Fisher RJ, et al. Randomized trial of short-course radiotherapy versus long-course chemoradiation comparing rates of local recurrence in patients with T3 rectal cancer: Trans-Tasman Radiation Oncology Group Trial 01.04. J Clin Oncol 2012;30(31):3827-33.
24. Vironen J, Juhola M, Kairaluoma M, et al. Tumour regression grading in the evaluation of tumour response after different preoperative radiotherapy treatments for rectal carcinoma. Int J Colorectal Dis 2005;20(5):440-5.
25. Yeh CH, Chen MF, Lai CH, et al. Comparison of treatment results between surgery alone, preoperative short-course radiotherapy, or long-course concurrent chemoradiotherapy in locally advanced rectal cancer. Int J Clin Oncol 2012;17(5):482-90.
26. Ansari N, Solomon MJ, Fisher RJ, et al. Acute Adverse Events and Postoperative Complications in a Randomized Trial of Preoperative Short-course Radiotherapy Versus Long-course Chemoradiotherapy for T3 Adenocarcinoma of the Rectum: Trans-Tasman Radiation Oncology Group Trial (TROG 01.04). Ann Surg 2017;265(5):882.
27. Guckenberger M, Wehner D, Sweeney RA, et al. Comparison of preoperative short-course radiotherapy and long-course radiochemotherapy for locally advanced rectal cancer. Strahlenther Onkol 2012;188(7):551-7.
28. Geva R, Itzkovich E, Shamai S, et al. Is there a role for adjuvant chemotherapy in pathological complete response rectal cancer tumors following neoadjuvant chemoradiotherapy? Journal of Cancer Research & Clinical Oncology 2014;140(9):1489-94.
29. Bökkerink GM, Graaf EJD, Punt CJ, et al. The CARTS study: Chemoradiation therapy for rectal cancer in the distal rectum followed by organ-sparing transanal endoscopic microsurgery. BMC Surgery 2011;11(1):34.
30. Pucciarelli S, De PA, Guerrieri M, et al. Local excision after preoperative chemoradiotherapy for rectal cancer: results of a multicenter phase II clinical trial. Dis Colon Rectum 2013;56(12):1349.
31. Zhou ZR, Liu SX, Zhang TS, et al. Short-course preoperative radiotherapy with immediate surgery versus long-course chemoradiation with delayed surgery in the treatment of rectal cancer: a systematic review and meta-analysis. Surg Oncol 2014;23(4):211-21.
32. Birgisson H, Pã¥Hlman L, Gunnarsson U, et al. Adverse effects of preoperative radiation therapy for rectal cancer: long-term follow-up of the Swedish Rectal Cancer Trial. J Clin Oncol 2005;23(34):8697-705.
33. Pettersson D, Holm T, Iversen H, et al. Preoperative short-course radiotherapy with delayed surgery in primary rectal cancer. Br J Surg 2012;99(4):577-83.
34. Bosset JF, Calais G, Mineur L, et al. Preoperative radiation (Preop RT) in rectal cancer: Effect and timing of additional chemotherapy (CT) 5-year results of the EORTC 22921 trial. J Clin Oncol 2005;23(16):247S.
35. Gérard JP, Conroy T, Bonnetain F, et al. Preoperative radiotherapy with or without concurrent fluorouracil and leucovorin in T3-4 rectal cancers: results of FFCD 9203. J Clin Oncol 2006;24(28):4620-5.
36. S. BOULIS-WASSIF FAG, J. LOYGUE, D. CAMELOT, M. BUYSE, N. DUEZlI. Final Results of a Randomized Trial on the Treatment of Rectal Cancer With Preoperative Radiotherapy Alone or in Combination With 5-Fluorouracil, Followed by Radical Surgery. Trial of the European Organization on Research and Treatment of Cancer Gastrointestinal Tract Cancer Cooperative Group. Cancer;53:1811-8.
Artículos relacionados

Carta

Vaginal lesion as first manifestation of colorectal disease

DOI: 10.17235/reed.2022.9270/2022

Carta

Sepsis secundaria a gastritis flemonosa en paciente oncológica

DOI: 10.17235/reed.2022.9009/2022

Imagen en Patología Digestiva

Gastroduodenal Burkitt’s lymphoma: a rare cause of epigastric pain and diarrhea

DOI: 10.17235/reed.2021.8150/2021

Imagen en Patología Digestiva

Primary synchronous rectal squamous-cell carcinoma and its exceptional response to chemoradiotherapy

DOI: 10.17235/reed.2021.8068/2021

Revisión

Enfermedad inflamatoria intestinal y trasplante de órganos sólido

DOI: 10.17235/reed.2020.7361/2020

Original

Can we optimize CEA as a response marker in rectal cancer?

DOI: 10.17235/reed.2020.7321/2020

Carta

Medullary colorectal carcinoma. Do we really know it?

DOI: 10.17235/reed.2020.6728/2019

Carta

Carcinoma de células en anillo de sello sobre pólipo juvenil

DOI: 10.17235/reed.2019.6299/2019

Carta

The rectosigmoid junction: are limits important?

DOI: 10.17235/reed.2019.5983/2018

Editorial

Cribado del cáncer colorrectal y supervivencia

DOI: 10.17235/reed.2018.5870/2018

Revisión

Lesiones serradas y síndrome de poliposis serrada

DOI: 10.17235/reed.2017.4065/2015

Carta al Editor

Metástasis traqueobronquiales de cáncer colorrectal

DOI: 10.17235/reed.2016.4080/2015

Caso Clínico

Carcinoma epidermoide primario de recto medio: una histología atípica

DOI: 10.17235/reed.2016.3975/2015

Instrucciones para citar
Yu Y, Li Y, Xu C, Zhang Z, Zhang X. Comparison of long course and short course preoperative radiotherapy in the treatment of locally advanced rectal cancer: a systematic review and meta-analysis. 5674/2018


Descargar en un gestor de citas

Descargue la cita de este artículo haciendo clic en uno de los siguientes gestores de citas:

Métrica
Este artículo ha sido visitado 979 veces.
Este artículo ha sido descargado 370 veces.

Estadísticas de Dimensions


Estadísticas de Plum Analytics

Ficha Técnica

Recibido: 25/04/2018

Aceptado: 29/06/2018

Prepublicado: 04/10/2018

Publicado: 17/01/2019

Tiempo de revisión del artículo: 63 días

Tiempo de prepublicación: 162 días

Tiempo de edición del artículo: 267 días


Compartir
Este artículo aun no tiene valoraciones.
Valoración del lector:
Valora este artículo:




Asociación Española de Ecografía Digestiva Sociedad Española de Endoscopia Digestiva Sociedad Española de Patología Digestiva
La REED es el órgano oficial de la Sociedad Española de Patología Digestiva, la SociedadEspañola de Endoscopia Digestiva y la Asociación Española de Ecografía Digestiva
Política de cookies Política de Privacidad Aviso Legal © Copyright 2023 y Creative Commons. Revista Española de Enfermedades Digestivas