Meta-analysis of randomized controlled trials of neoadjuvant radiotherapy and chemoradiotherapy combined with TME surgery for locally advanced rectal cancer

Abstract

Objective to evaluate the safety and efficacy of neoadjuvant radiotherapy and neoadjuvant chemoradiotherapy combined with total mesorectal excision (TME) in the treatment for locally advanced rectal cancer. Methods Database including PubMed, ovid, Cochrane library, Chinese biomedical literature database ( CBM ), CNKI and Wanfang were retrieved from 2002 to 2017 on neoadjuvant therapy combined with TME surgery for locally advanced rectal cancer.The quality of the literatures that met the inclusion criteria were evaluated. Revman 5.0 software was used to examine the heterogeneity and meta-analysis was performed. Results A total of 4 randomized controlled trials involving 2272 rectal cancer patients were included in the study. There were 1133 patients in the neoadjuvant chemoradiotherapy group and 1139 patients in the neoadjuvant radiotherapy group. Compared with the neoadjuvant chemoradiotherapy y group, the complete pathological remission rate was lower in neoadjuvant radiotherapy group (OR=0.32, 95 % CI: 0.22-0.44, P<0.05 ), with higher 5-years local recurrence rate (OR=2.13, 95 % CI: 1.62-2.79, P<0.05 ), however with less serious adverse reactions (OR=0.38, 95 % CI: 0.17-0.82, P=0.01), with statistically significant difference. However, there was no significant difference of anus-preserving rate, postoperative complication rate, 5-years disease-free survival rate and overall survival rate. Conclusion Neoadjuvant chemoradiotherapy is generally superior to neoadjuvant radiotherapy alone in the treatment for advanced rectal cancer, but it is still necessary to choose a suitable neoadjuvant treatment plan according to the patient’s tolerance in clinical application. Key words: Rectal Neoplasms; Mesentery; Radiotherapy, Adjuvant; Chemotherapy, Adjuvant; Meta-Analysis