Abstract
Purpose: To evaluate the impact of interval between chemoradiotherapy (CRT) and surgery on rates of pathological complete response (pCR). Methods: A search was carried out from PubMed and Embase databases for literature related to clinical benefits in rectal cancer patients after surgery performed at different intervals following neoadjuvant therapy. The main endpoint was the rate of pCR. Relative risk (RR) of chance of a pCR among different intervals was assessed. Results: Among 3462 screened individuals, 11 retrospective cohort studies representing 3462 relevant patients were qualified for inclusion in the study. The time intervals varied between ≤ 5 weeks and > 12 weeks. Thell studies were divided into 6 categories based on surgical timing. The potential association between the pCR rate and time intervals of 5, 6, 7, 8, 10 or 12 weeks was analyzed. Pooled RR and 95 % confidence intervals (CIs) of pCR rates at different intervals were plotted on a line chart. The highest plateau in the RR of pCR rates were noted in patients undergoing surgery beyond 7 weeks (RR, 1.60; 95 % CI, 1.20 – 2.13; p = 0.001) after the end of CRT. Conclusion: Radical operation over 7 weeks following CRT results in the highest risk of pCR. The question as to whether this is associated with high long-term survival rate remains to be resolved. Keywords: Rectal cancer, Time interval, Surgery, Chemotherapy, Radiotherapy
Highlights
CRT after surgery has become a routine procedure of multimodal treatment in patients with locally-advanced rectal cancer [1,2]
A metaanalysis consisting of randomized-controlled studies suggested that preoperative CRT improves local control compared with surgery alone or surgery combined with neoadjuvant radiotherapy
Two investigators searched PubMed and Embase databases for relevant article; electronic database searches were performed with the Boolean combination [(Interval or time or timing) and rectal and and (Chemoradiotherapy OR Radiotherapy OR radiation OR neoadjuvant)] in all fields
Summary
CRT after surgery has become a routine procedure of multimodal treatment in patients with locally-advanced rectal cancer [1,2]. A metaanalysis consisting of randomized-controlled studies suggested that preoperative CRT improves local control compared with surgery alone or surgery combined with neoadjuvant radiotherapy. Complete response to preoperative CRT predicts better long-term outcomes with low rates of local recurrence and distant failure. There is lack of level-1 evidence that patients have obtained larger tumor shrinkage if the surgical timing was deferred for several weeks and conflicting data exist. The best time interval between CRT and surgery which yields the maximal tumor regression is still unknown, and quantitative summarization of the supporting evidence is not available. This systematic review aims to examine the impact of the CRT-surgery time interval on the rate of pCR
Sign-in/Register to view highlights & summary Sign-in/Register to access full text options 
Talk to us
Join us for a 30 min session where you can share your feedback and ask us any queries you have
Schedule a callDisclaimer: All third-party content on this website/platform is and will remain the property of their respective owners and is provided on "as is" basis without any warranties, express or implied. Use of third-party content does not indicate any affiliation, sponsorship with or endorsement by them. Any references to third-party content is to identify the corresponding services and shall be considered fair use under The CopyrightLaw.
