Preoperative chemoradiation versus radiation alone for stage II and III resectable rectal cancer
Sübutlu məlumatların xülasələri
16.07.2017 • Sonuncu dəyişiklik 16.07.2017
Editors
Compared to preoperative radiotherapy alone, preoperative chemoradiation (CRT) may not increase overall survival or disease-free survival, although it enhances pathological response and improves local control in resectable stage II and III rectal cancer. The effects of preoperative CRT on functional outcome and quality of life are incompletely understood.
Summary
A Cochrane review
included studies with a total of subjects.
A Cochrane review included 5 studies. The addition of chemotherapy to preoperative RT significantly increased grade III and IV acute toxicity (OR 1.68-10, P = 0.002) and marginally affected postoperative overall morbidity (OR 0.67-1.00, P = 0.05) while no differences were observed in postoperative mortality or anastomotic leak rate. Compared to preoperative RT alone, preoperative CRT significantly increased the rate of complete pathological response (OR 2.12-5.84, P < 0.00001) although this did not translate into a higher sphincter preservation rate (OR 0.92-1.30, P = 0.32). The incidence of local recurrence at five years was significantly lower in the CRT group compared to RT alone (OR 0.39-0.72, P < 0.001). No statistically significant differences were observed in DFS (OR 0.92-1.34, P = 0.27) or OS (OR 0.79-1.14, P = 0.58) at five years.
Comment: The quality of evidence is downgraded by inconsistency (different results for different outcomes) and by indirectness (the follow up time of the included trials may be too short to observe a survival benefit).
Ədəbiyyat
- De Caluwé L, Van Nieuwenhove Y, Ceelen WP. Preoperative chemoradiation versus radiation alone for stage II and III resectable rectal cancer. Cochrane Database Syst Rev 2013;(2):CD006041.