Short-course preoperative radiotherapy with immediate surgery versus long-course chemoradiotherapy with delayed surgery in treatment of rectal cancer: a meta-analysis

Abstract

Objective At present, short-course radiotherapy (SCRT) with immediate surgery and long-course chemoradiotherapy (LCRT) with delayed surgery are extremely important regimens in the treatment of rectal cancer. In this meta-analysis, the clinical efficacy and safety were statistically compared between two regimes. Methods Literatures related to SCRT and LCRT including randomized controlled studies and clinical studies were searched from Cochrane Library, PubMed, Embase, China National Knowledge Infrastructure (CNKI) and Wanfang database with regard to SCRT with immediate surgery or LCRT with delayed surgery. Meta-analysis was conducted by using RevMan 5.3 software. Results Ten studies were finally selected including 5 randomized controlled trials. Meta-analysis demonstrated that the RO resection rate, T downstaging rate, pathological complete response (pCR) rate in the LCRT group were significantly higher than those in the SCRT group. The incidence rate of adverse events in the LCRT group was higher compared with that in the SCRT group. The sphincter-preservation rate, local recurrence rate, distant metastasis rate, disease-free survival rate, overall survival, late toxicity and postoperative complications did not significantly differ between two groups (all P>0.05). Conclusions Compared with SCRT, LCRT can increase the T downstaging rate, R0 resection rate and pCR rate, whereas elevate the incidence rate of acute adverse events. LCRT exerts no significant effect upon overall postoperative complications. Key words: Rectal neoplasm/radiotherapy; Rectal neoplasm/chemoradiotherapy; Rectal neoplasm/surgery; Meta-analysis