Total neoadjuvant therapy based on short-course radiotherapy versus standard long-course chemoradiotherapy for locally advanced rectal cancer: a systematic review and meta-analysis of randomized controlled trials
BackgroundWe conducted the meta-analysis to compare the therapeutic effects of total neoadjuvant therapy (TNT) based on short-course radiotherapy followed by consolidation chemotherapy (SCRT/CCT) and long-course chemoradiotherapy (LCCRT) for locally advanced rectal cancer (LARC) according to certain...
Saved in:
| Main Authors: | , , , , , , , , |
|---|---|
| Format: | Article |
| Language: | English |
| Published: |
Frontiers Media S.A.
2024-12-01
|
| Series: | Frontiers in Oncology |
| Subjects: | |
| Online Access: | https://www.frontiersin.org/articles/10.3389/fonc.2024.1515756/full |
| Tags: |
Add Tag
No Tags, Be the first to tag this record!
|
| _version_ | 1841536669204873216 |
|---|---|
| author | Wenji Pu Wenji Pu Wenji Pu Wenqi Chen Haiman Jing Jishi Li Yong Jiang Shasha Li Weijie Wen Zhiyuan Xu Jing Jin |
| author_facet | Wenji Pu Wenji Pu Wenji Pu Wenqi Chen Haiman Jing Jishi Li Yong Jiang Shasha Li Weijie Wen Zhiyuan Xu Jing Jin |
| author_sort | Wenji Pu |
| collection | DOAJ |
| description | BackgroundWe conducted the meta-analysis to compare the therapeutic effects of total neoadjuvant therapy (TNT) based on short-course radiotherapy followed by consolidation chemotherapy (SCRT/CCT) and long-course chemoradiotherapy (LCCRT) for locally advanced rectal cancer (LARC) according to certain significant randomized controlled trials (RCTs).MethodsThe researchers retrieved several databases, including PubMed, Embase, Web of Science, and the Cochrane Library, to collect all the relevant literature published since the establishment of the databases until July 30, 2024, and then screened to determine the qualified literature and extracted the relevant information. Finally, RevMan 5.4 software was utilized to conduct the meta-analysis for determining the 95% confidence interval (CI) and pooled risk ratio (RR). There were 9 study indicators, including the pathologic complete remission (pCR) rate, tumor downstaging rate, R0 resection rate, sphincter preservation rate, disease-free survival (DFS), overall survival (OS), acute ≥3 grade toxicity rate, surgery complication rate, and distant recurrence rate. When moderate, even severe, heterogeneity was found, a random-effect model was applied; otherwise, a fixed-effect model was used for the analysis.ResultsA total of 6 eligible RCTs and 2259 participants were included in this meta-analysis. Compared with the standard LCCRT, TNT treatment on the basis of SCRT/CCT increased the pCR rate significantly [RR = 1.67, 95% CI (1.36, 2.04), P < 0.00001], especially in ≥ 4 cycles of the CCT arm [RR = 1.77, 95% CI: (1.41–2.23), p < 0.00001], and led to a similar tumor downstaging rate [RR = 0.99, 95% CI (0.85, 1.15), P = 0.92]. Moreover, survival outcomes, distant recurrence rate, and surgical indicators were comparable between the two groups.ConclusionFor LARC patients, the SCRT/CCT regimen not only has a higher pCR rate, equivalent OS, and comparable additional indicators versus standard LCCRT but also shortens the treatment time, costs less, and improves patients’ adherence to the innovative anti-tumor therapy; hence, with the concept of acute toxicity control, it could be further widely and safely utilized, especially in resource-limited settings.Systematic review registrationhttps://www.crd.york.ac.uk/prospero/, identifier CRD42024600180. |
| format | Article |
| id | doaj-art-9781c238c5284310b3fb942c2d8416d4 |
| institution | Kabale University |
| issn | 2234-943X |
| language | English |
| publishDate | 2024-12-01 |
| publisher | Frontiers Media S.A. |
| record_format | Article |
| series | Frontiers in Oncology |
| spelling | doaj-art-9781c238c5284310b3fb942c2d8416d42025-01-14T12:05:56ZengFrontiers Media S.A.Frontiers in Oncology2234-943X2024-12-011410.3389/fonc.2024.15157561515756Total neoadjuvant therapy based on short-course radiotherapy versus standard long-course chemoradiotherapy for locally advanced rectal cancer: a systematic review and meta-analysis of randomized controlled trialsWenji Pu0Wenji Pu1Wenji Pu2Wenqi Chen3Haiman Jing4Jishi Li5Yong Jiang6Shasha Li7Weijie Wen8Zhiyuan Xu9Jing Jin10Department of Clinical Oncology, The University of Hong Kong-Shenzhen Hospital, Shenzhen, ChinaMedical Department of Shenzhen University, General Hospital of Shenzhen University, Academy of Clinical Medicine of Shenzhen University, Shenzhen, ChinaNational Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital & Shenzhen Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Shenzhen, ChinaDepartment of Clinical Oncology, The University of Hong Kong-Shenzhen Hospital, Shenzhen, ChinaDepartment of Clinical Oncology, The University of Hong Kong-Shenzhen Hospital, Shenzhen, ChinaDepartment of Clinical Oncology, The University of Hong Kong-Shenzhen Hospital, Shenzhen, ChinaDepartment of Clinical Oncology, The University of Hong Kong-Shenzhen Hospital, Shenzhen, ChinaDepartment of Clinical Oncology, The University of Hong Kong-Shenzhen Hospital, Shenzhen, ChinaDepartment of Clinical Oncology, The University of Hong Kong-Shenzhen Hospital, Shenzhen, ChinaDepartment of Clinical Oncology, The University of Hong Kong-Shenzhen Hospital, Shenzhen, ChinaNational Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital & Shenzhen Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Shenzhen, ChinaBackgroundWe conducted the meta-analysis to compare the therapeutic effects of total neoadjuvant therapy (TNT) based on short-course radiotherapy followed by consolidation chemotherapy (SCRT/CCT) and long-course chemoradiotherapy (LCCRT) for locally advanced rectal cancer (LARC) according to certain significant randomized controlled trials (RCTs).MethodsThe researchers retrieved several databases, including PubMed, Embase, Web of Science, and the Cochrane Library, to collect all the relevant literature published since the establishment of the databases until July 30, 2024, and then screened to determine the qualified literature and extracted the relevant information. Finally, RevMan 5.4 software was utilized to conduct the meta-analysis for determining the 95% confidence interval (CI) and pooled risk ratio (RR). There were 9 study indicators, including the pathologic complete remission (pCR) rate, tumor downstaging rate, R0 resection rate, sphincter preservation rate, disease-free survival (DFS), overall survival (OS), acute ≥3 grade toxicity rate, surgery complication rate, and distant recurrence rate. When moderate, even severe, heterogeneity was found, a random-effect model was applied; otherwise, a fixed-effect model was used for the analysis.ResultsA total of 6 eligible RCTs and 2259 participants were included in this meta-analysis. Compared with the standard LCCRT, TNT treatment on the basis of SCRT/CCT increased the pCR rate significantly [RR = 1.67, 95% CI (1.36, 2.04), P < 0.00001], especially in ≥ 4 cycles of the CCT arm [RR = 1.77, 95% CI: (1.41–2.23), p < 0.00001], and led to a similar tumor downstaging rate [RR = 0.99, 95% CI (0.85, 1.15), P = 0.92]. Moreover, survival outcomes, distant recurrence rate, and surgical indicators were comparable between the two groups.ConclusionFor LARC patients, the SCRT/CCT regimen not only has a higher pCR rate, equivalent OS, and comparable additional indicators versus standard LCCRT but also shortens the treatment time, costs less, and improves patients’ adherence to the innovative anti-tumor therapy; hence, with the concept of acute toxicity control, it could be further widely and safely utilized, especially in resource-limited settings.Systematic review registrationhttps://www.crd.york.ac.uk/prospero/, identifier CRD42024600180.https://www.frontiersin.org/articles/10.3389/fonc.2024.1515756/fulllocally advanced rectal cancershort-course radiotherapyconsolidation chemotherapytotal neoadjuvant therapyneoadjuvant chemoradiotherapypathological complete response |
| spellingShingle | Wenji Pu Wenji Pu Wenji Pu Wenqi Chen Haiman Jing Jishi Li Yong Jiang Shasha Li Weijie Wen Zhiyuan Xu Jing Jin Total neoadjuvant therapy based on short-course radiotherapy versus standard long-course chemoradiotherapy for locally advanced rectal cancer: a systematic review and meta-analysis of randomized controlled trials Frontiers in Oncology locally advanced rectal cancer short-course radiotherapy consolidation chemotherapy total neoadjuvant therapy neoadjuvant chemoradiotherapy pathological complete response |
| title | Total neoadjuvant therapy based on short-course radiotherapy versus standard long-course chemoradiotherapy for locally advanced rectal cancer: a systematic review and meta-analysis of randomized controlled trials |
| title_full | Total neoadjuvant therapy based on short-course radiotherapy versus standard long-course chemoradiotherapy for locally advanced rectal cancer: a systematic review and meta-analysis of randomized controlled trials |
| title_fullStr | Total neoadjuvant therapy based on short-course radiotherapy versus standard long-course chemoradiotherapy for locally advanced rectal cancer: a systematic review and meta-analysis of randomized controlled trials |
| title_full_unstemmed | Total neoadjuvant therapy based on short-course radiotherapy versus standard long-course chemoradiotherapy for locally advanced rectal cancer: a systematic review and meta-analysis of randomized controlled trials |
| title_short | Total neoadjuvant therapy based on short-course radiotherapy versus standard long-course chemoradiotherapy for locally advanced rectal cancer: a systematic review and meta-analysis of randomized controlled trials |
| title_sort | total neoadjuvant therapy based on short course radiotherapy versus standard long course chemoradiotherapy for locally advanced rectal cancer a systematic review and meta analysis of randomized controlled trials |
| topic | locally advanced rectal cancer short-course radiotherapy consolidation chemotherapy total neoadjuvant therapy neoadjuvant chemoradiotherapy pathological complete response |
| url | https://www.frontiersin.org/articles/10.3389/fonc.2024.1515756/full |
| work_keys_str_mv | AT wenjipu totalneoadjuvanttherapybasedonshortcourseradiotherapyversusstandardlongcoursechemoradiotherapyforlocallyadvancedrectalcancerasystematicreviewandmetaanalysisofrandomizedcontrolledtrials AT wenjipu totalneoadjuvanttherapybasedonshortcourseradiotherapyversusstandardlongcoursechemoradiotherapyforlocallyadvancedrectalcancerasystematicreviewandmetaanalysisofrandomizedcontrolledtrials AT wenjipu totalneoadjuvanttherapybasedonshortcourseradiotherapyversusstandardlongcoursechemoradiotherapyforlocallyadvancedrectalcancerasystematicreviewandmetaanalysisofrandomizedcontrolledtrials AT wenqichen totalneoadjuvanttherapybasedonshortcourseradiotherapyversusstandardlongcoursechemoradiotherapyforlocallyadvancedrectalcancerasystematicreviewandmetaanalysisofrandomizedcontrolledtrials AT haimanjing totalneoadjuvanttherapybasedonshortcourseradiotherapyversusstandardlongcoursechemoradiotherapyforlocallyadvancedrectalcancerasystematicreviewandmetaanalysisofrandomizedcontrolledtrials AT jishili totalneoadjuvanttherapybasedonshortcourseradiotherapyversusstandardlongcoursechemoradiotherapyforlocallyadvancedrectalcancerasystematicreviewandmetaanalysisofrandomizedcontrolledtrials AT yongjiang totalneoadjuvanttherapybasedonshortcourseradiotherapyversusstandardlongcoursechemoradiotherapyforlocallyadvancedrectalcancerasystematicreviewandmetaanalysisofrandomizedcontrolledtrials AT shashali totalneoadjuvanttherapybasedonshortcourseradiotherapyversusstandardlongcoursechemoradiotherapyforlocallyadvancedrectalcancerasystematicreviewandmetaanalysisofrandomizedcontrolledtrials AT weijiewen totalneoadjuvanttherapybasedonshortcourseradiotherapyversusstandardlongcoursechemoradiotherapyforlocallyadvancedrectalcancerasystematicreviewandmetaanalysisofrandomizedcontrolledtrials AT zhiyuanxu totalneoadjuvanttherapybasedonshortcourseradiotherapyversusstandardlongcoursechemoradiotherapyforlocallyadvancedrectalcancerasystematicreviewandmetaanalysisofrandomizedcontrolledtrials AT jingjin totalneoadjuvanttherapybasedonshortcourseradiotherapyversusstandardlongcoursechemoradiotherapyforlocallyadvancedrectalcancerasystematicreviewandmetaanalysisofrandomizedcontrolledtrials |