O130 Transarterial chemoembolization in rectal cancer: a systematic review

Abstract

Abstract Background Locally advanced rectal cancer (LARC) is typically treated with neoadjuvant chemoradiotherapy. Response can be unpredictable, with 8-20% of patients achieving complete pathological response, whilst 20-30% have no response or progression. Transarterial chemoembolisation (TACE) is established as a non-surgical option to treat colorectal liver metastases by delivering chemotherapy and an embolic agent via its primary arterial supply. This allows for reduction in systemic toxicity whilst delivering higher doses to tumours. There have been trials of TACE in LARC, but its role as a therapeutic modality is still unknown. Therefore, this review aims to assess existing evidence of TACE in LARC and whether it warrants further investigation as a treatment. Methods A systematic literature search was performed according to Preferred Reporting Items for Systematic Reviews and Meta-Analyses. Databases searched included PubMed, Scopus and Web of Science. Risk of bias was assessed using the Newcastle-Ottawa scale. The assessed outcomes included complete pathological response, objective response rate, complications, recurrence, disease-free and overall survival. Results Five reports were considered for inclusion. Minimal complications and adverse events were noted. Improved pathological complete response or objective response rates were noted in four out of five studies when compared to systemic neoadjuvant regimes. One study showed TACE reduced the risk of distant recurrence. Significant heterogeneity and bias were noted in all studies. Conclusion TACE is a safe modality, but its superiority over conventional treatment has yet to be demonstrated. Current literature is of inadequate quality but warrants further investigation in preclinical and clinical settings.