Clinical benefit of adding oxaliplatin to standard neoadjuvant chemoradiotherapy in locally advanced rectal cancer: a meta-analysis

Abstract

BackgroundNeoadjuvant fluoropirimidine (5FU)-based chemoradiotherapy (CRT) has been considered the standard of care for locally advanced rectal cancer (LARC). Whether addition of oxaliplatin (OXP) will further improve clinical outcomes is still debated. We conducted a meta-analysis to evaluate the role of OXP in this patient population.MethodsLiterature searches were carried out in PubMed, Medline and Scopus databases. End points were overall survival (OS), disease free survival (DFS), local failure (LF) and distant failure (DF). Odd ratio (OR) with 95% confidence interval (CI) was calculated using random effects model.ResultsFour randomized trials were included. Patients treated with OXP-5FU CRT had significantly decreased DF (OR = 0.76; 95% CI, 0.60 to 0.97; p = 0.03) compared to standard CRT. OS, DFS and LF were not significantly different between groups.ConclusionsOXP significantly decreased DF, but does not improve OS e DFS compared to 5FU CRT. Precise role of OXP in neoadjuvant setting of LARC remains to be determined.

Tumour regression after radiotherapy for rectal cancer – Results from the randomised Stockholm III trial

“…Two meta-analyses concluded decreased risk for DM but without any improvement of DFS or OS. 137,138 Short course radiotherapy…”

Intensified Neoadjuvant Chemoradiotherapy for Locally Advanced Rectal Cancer in Elderly Patients: Toxicity, Disease Control, and Survival Outcomes

“…A recent meta-analysis suggested a significant clinical benefit in terms of distant failure by adding oxaliplatin to the standard fluoropyrimidine-based CRT. 4 However, among the trials included, it was not possible to extrapolate patient age details; thus, a subsequent subset analysis was not performed. Definitive conclusions are still pending, and further clinical data are paramount to better clarify the precise role of the intensified neoadjuvant approach, especially for elderly patients.…”

Comparison of volumetric-modulated arc therapy using simultaneous integrated boosts (SIB-VMAT) of 45 Gy/55 Gy in 25 fractions with conventional radiotherapy in preoperative chemoradiation for rectal cancers: a propensity score case-matched analysis

“…There have now been seven major trials on oxaliplatin [ 17 – 23 ] and two of those demonstrated a benefit for oxaliplatin regarding DFS [ 20 , 23 ]. Meta-analyses have also demonstrated this benefit [ 24 , 25 ]. In patients receiving neoadjuvant treatment, CRM positivity is one of the strongest predictive factors of local recurrence [ 26 ].…”