Abstract
Background and purposeThe role of preoperative short-course radiotherapy (SCRT) in rectal cancer treatment, when compared to long-course radiochemotherapy (LCRT), is still controversial. Thus the meta-analysis with trial sequential analysis (TSA) was performed to evaluate the long-term survival of SCRT and LCRT as therapeutic regimens for locally advanced rectal cancer.Material and methodsPubMed, Embase, and the Cochrane Central Register of Controlled Trials were searched up to August 2017 for eligible studies. Hazard ratios (HRs) or odds ratios (ORs) of overall survival (OS), disease free survival (DFS) and local recurrence (LR) with the corresponding 95% confidence intervals (CIs) were calculated and TSA was applied.Results11 studies with 1984 patients were included. There was no significant difference in OS (HR = 0.92, 95% CI: 0.75–1.13, p = 0.44), DFS (HR = 0.94, 95% CI: 0.79–1.12, p = 0.50) and LR (OR = 0.73, 95% CI: 0.49–1.08, p = 0.11) between SCRT and LCRT groups. TSA suggested firm evidence for lacking on average a -10% relative risk reduction (RRR) in 4-year OS but no statistical significance in 4-year DFS.ConclusionsPreoperative SCRT is as effective as LCRT for locally advanced colorectal cancer in long-term survival. SCRT could be preferential while facing long waiting lists or lacking medical resource.
Highlights
Preoperative radiotherapy has been shown conclusively to improve local control for rectal cancer [1,2]
There was no significant difference in overall survival (OS) (HR = 0.92, 95% confidence intervals (CIs): 0.75–1.13, p = 0.44), disease free survival (DFS) (HR = 0.94, 95% CI: 0.79–1.12, p = 0.50) and local recurrence (LR) (OR = 0.73, 95% CI: 0.49–1.08, p = 0.11) between short-course radiotherapy (SCRT) and long-course radiochemotherapy (LCRT) groups
Preoperative SCRT is as effective as LCRT for locally advanced colorectal cancer in longterm survival
Summary
Preoperative radiotherapy has been shown conclusively to improve local control for rectal cancer [1,2]. For locally advanced stage II-III resectable rectal cancer (mostly cT3 without threatened or involved mesorectal fascia), either preoperative short-course radiotherapy (SCRT) of 25 Gy in 5 consecutive days or long-course chemoradiotherapy (LCRT) (45-50Gy, 1.8-2Gy/fr with concomitant 5-FU-based chemotherapy) followed by radical Total Mesorectal Excision is recommended [3,4]. The role of preoperative short-course radiotherapy (SCRT) in rectal cancer treatment, when compared to long-course radiochemotherapy (LCRT), is still controversial. The metaanalysis with trial sequential analysis (TSA) was performed to evaluate the long-term survival of SCRT and LCRT as therapeutic regimens for locally advanced rectal cancer
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