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Qiaoli W, Yongping H, Wei X, Guoqiang X, Yunhe J, Qiuyan L, Cheng L, Mengling G, Jiayi L, Wei X, Yi Y. Preoperative short-course radiotherapy (5 × 5 Gy) with delayed surgery versus preoperative long-course radiotherapy for locally resectable rectal cancer: a meta-analysis. Int J Colorectal Dis 2019; 34:2171-2183. [PMID: 31745621 DOI: 10.1007/s00384-019-03433-9] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 10/17/2019] [Indexed: 02/06/2023]
Abstract
PURPOSE Preoperative short-course radiotherapy (PSRT) and preoperative long-course radiotherapy (PLRT) are standard treatment regimens for locally advanced rectal cancer. However, whether the efficacy and safety of PSRT with delayed surgery (more than 4 weeks) are superior to those of PLRT remains unresolved and was explored in this meta-analysis. METHODS Studies published in PubMed, Embase, the Cochrane Library, and ClinicalTrials.gov databases were systematically searched. RevMan 5.3 was used to calculate pooled hazard ratios (HR) and relative risk (RR). RESULTS Seven studies including 4973 patients were identified in the meta-analysis. Pooled statistics showed that there was no statistically significant difference in overall survival (HR = 1.30, 95% CI 0.58-2.89, P = 0.52) or disease-free survival (HR = 1.10, 95% CI 0.73-1.66, P = 0.64) between the preoperative short-course and long-course radiotherapy groups. Moreover, pathological complete remission, early postoperative complications, treatment-related grade 3/4 toxicity, local recurrence, and distant metastasis were similar between the two groups. Interestingly, a subgroup analysis revealed that preoperative short-course radiotherapy without adjuvant chemotherapy not only resulted in lower treatment-related grade 3/4 toxicity than the long-course radiotherapy group (RR = 0.19, 95% CI 0.08-0.48, P < 0.01) but also resulted in significantly lower overall survival and pathological complete remission (P = 0.02, P < 0.01, respectively). Disappointingly, pooled statistics observed few advantages over long-course radiotherapy in short-course radiotherapy with the adjuvant chemotherapy subgroup. CONCLUSIONS PSRT with delayed surgery was as effective as PLRT for the management of locally resectable rectal cancer. However, not adding additional chemotherapy to PSRT not only significantly decreased grade 3/4 toxicity but also decreased pathological complete remission and overall survival. TRIAL REGISTRATION The protocol for this meta-analysis was prospectively registered with PROSPERO (CRD42019133641).
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Affiliation(s)
- Wang Qiaoli
- Department of Radiotherapy, Yunnan Cancer Hospital, the Third Affiliated Hospital of Kunming Medical University, 519 Kunzhou Road, Xishan District, Kunming City, 650118, Yunnan Province, China
| | - Huang Yongping
- Department of Thoracic Surgery, Yunnan Cancer Hospital, the Third Affiliated Hospital of Kunming Medical University, Kunming, Yunnan, China
| | - Xiong Wei
- Department of Cancer Colorectal Surgery, Yunnan Cancer Hospital, the Third Affiliated Hospital of Kunming Medical University, Kunming, Yunnan, China
| | - Xu Guoqiang
- Department of Radiotherapy, Yunnan Cancer Hospital, the Third Affiliated Hospital of Kunming Medical University, 519 Kunzhou Road, Xishan District, Kunming City, 650118, Yunnan Province, China
| | - Ju Yunhe
- Department of Radiotherapy, Yunnan Cancer Hospital, the Third Affiliated Hospital of Kunming Medical University, 519 Kunzhou Road, Xishan District, Kunming City, 650118, Yunnan Province, China
| | - Liu Qiuyan
- Department of Radiotherapy, Yunnan Cancer Hospital, the Third Affiliated Hospital of Kunming Medical University, 519 Kunzhou Road, Xishan District, Kunming City, 650118, Yunnan Province, China
| | - Li Cheng
- Department of Radiotherapy, Yunnan Cancer Hospital, the Third Affiliated Hospital of Kunming Medical University, 519 Kunzhou Road, Xishan District, Kunming City, 650118, Yunnan Province, China
| | - Guo Mengling
- Yunnan Cancer Institute, Yunnan Cancer Hospital, the Third Affiliated Hospital of Kunming Medical University, Kunming, Yunnan, China
| | - Li Jiayi
- Department of Cancer Colorectal Surgery, Yunnan Cancer Hospital, the Third Affiliated Hospital of Kunming Medical University, Kunming, Yunnan, China
| | - Xiong Wei
- Department of Radiotherapy, Yunnan Cancer Hospital, the Third Affiliated Hospital of Kunming Medical University, 519 Kunzhou Road, Xishan District, Kunming City, 650118, Yunnan Province, China.
| | - Yang Yi
- Department of Radiotherapy, Yunnan Cancer Hospital, the Third Affiliated Hospital of Kunming Medical University, 519 Kunzhou Road, Xishan District, Kunming City, 650118, Yunnan Province, China.
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Roy A, Mahasittiwat P, Weiner AA, Hunt SR, Mutch MG, Birnbaum EH, Kodner IJ, Read TE, Fleshman JW, Olsen JR, Myerson RJ, Parikh PJ. Preoperative short-course radiation therapy for rectal cancer provides excellent disease control and toxicity: Results from a single US institution. Pract Radiat Oncol 2016; 7:e51-e58. [PMID: 27720702 DOI: 10.1016/j.prro.2016.08.010] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2016] [Revised: 08/19/2016] [Accepted: 08/23/2016] [Indexed: 12/14/2022]
Abstract
PURPOSE Preoperative short-course radiation therapy (SCRT) has rarely been used for rectal cancer in the United States, although 2 randomized phase 3 trials demonstrate equivalence to conventional chemoradiation (CRT), and recent updates to national guidelines include this regimen as a treatment option. We sought to evaluate the efficacy and safety of preoperative SCRT followed by immediate surgery within 1 week to treat rectal cancer in the US setting. METHODS AND MATERIALS All patients treated with preoperative SCRT (4 Gy × 5 fractions for total 20 Gy) followed by planned surgery within 1 week at our institution were retrospectively evaluated. Censored cases with ≥2 years of follow-up were included along with any disease failure or death. Patients with cM1 disease were excluded. Patients with yp stage II/III disease typically received adjuvant chemotherapy from the 1990s onwards. The primary outcomes were actuarial (Kaplan-Meier) 5-year locoregional control (LC), disease-free survival (DFS), and overall survival (OS) as well as late severe (greater than or equal to grade 3) toxicity. RESULTS Our analysis included 202 consecutive patients with clinical stage I-III disease treated from 1977 through 2011. Median follow-up was 6.5 years (range, 2-29.2). Five-year disease outcomes were 95.9% ± 1.5% for LC, 76.4% ± 3.1% for DFS, and 84.6% ± 2.6% for OS. For patients with locally advanced rectal cancer (cT3-4 and/or cN+), 5-year LC, DFS, and OS were 95.1% ± 2.1%, 73.3% ± 4.3%, and 80.6% ± 3.7%, respectively. The late severe toxicity rate was 11.4%. CONCLUSIONS SCRT followed by immediate surgery is a safe and effective treatment for patients with rectal cancer in the United States. Though SCRT has not been widely adopted, recent updates to the national guidelines for rectal cancer as well as financial pressures to reduce healthcare costs may lead to increased utilization of this treatment regimen in the future.
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Affiliation(s)
- Amit Roy
- Department of Radiation Oncology, Washington University School of Medicine, St. Louis, Missouri
| | - Pawinee Mahasittiwat
- Cancer Center, Siriraj Piyamaharajkarun Hospital, Mahidol University, Bangkok, Thailand
| | - Ashley A Weiner
- Department of Radiation Oncology, Washington University School of Medicine, St. Louis, Missouri
| | - Steven R Hunt
- Department of Surgery, Section of Colorectal Surgery, Washington University School of Medicine, St. Louis, Missouri
| | - Matthew G Mutch
- Department of Surgery, Section of Colorectal Surgery, Washington University School of Medicine, St. Louis, Missouri
| | - Elisa H Birnbaum
- Department of Surgery, Section of Colorectal Surgery, Washington University School of Medicine, St. Louis, Missouri
| | - Ira J Kodner
- Department of Surgery, Section of Colorectal Surgery, Washington University School of Medicine, St. Louis, Missouri
| | - Thomas E Read
- Department of Colon and Rectal Surgery, Lahey Hospital and Medical Center, Burlington, Massachusetts; Department of Surgery, Tufts University School of Medicine, Boston, Massachusetts
| | - James W Fleshman
- Department of Surgery, Baylor University Medical Center at Dallas, Dallas, Texas
| | - Jeffrey R Olsen
- Department of Radiation Oncology, Washington University School of Medicine, St. Louis, Missouri
| | - Robert J Myerson
- Department of Radiation Oncology, Washington University School of Medicine, St. Louis, Missouri
| | - Parag J Parikh
- Department of Radiation Oncology, Washington University School of Medicine, St. Louis, Missouri.
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