Does a long interval between neoadjuvant chemoradiotherapy and surgery benefit the clinical outcomes of locally advanced rectal cancer? A systematic review and meta analyses

Yu, Miao; Wang, Deng-Chao; Li, Sheng; Huang, Liyan; Ji, Wei

doi:10.1007/s00384-022-04122-w

Cited by 13 publications

(13 citation statements)

References 44 publications

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“…Data emerging from other solid tumors imply that a longer time interval between NACT and surgery could affect prognosis [18,19]. In breast cancer, there are studies supporting that breast surgery within three weeks after the completion of NACT would be of maximal bene t [18].…”

Section: Discussionmentioning

confidence: 99%

Optimal Time Interval Between Neoadjuvant Platinum-based Chemotherapy and Interval Debulking Surgery in High-grade Serous Ovarian Cancer

Andrikopoulou

Liontos

Apostolidou

et al. 2022

Preprint

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BACKGROUND There is limited data on the optimal time interval between the last dose of neoadjuvant chemotherapy (NACT) and interval debulking surgery (IDS) in high-grade serous ovarian carcinoma (HGSC). METHODS We retrospectively identified patients with stage IIIC/IV HGSC who received NACT followed by IDS during a 15-year period (January 2003-December 2018) in our Institution that is certified by the European Society of Gynecologic Oncology (ESGO) as a center of excellence for the treatment of ovarian cancer. RESULTS Overall, 115 patients with HGSC stage IIIC/IV were included. Median age of diagnosis was 62.7 years (IQR: 14.0). 76.5% (88/115) of patients were diagnosed with IIIC HGSC and 23.5% (27/115) with IV HGSC. Median PFS was 15.7 months (95% CI: 13.0–18.5) and median OS was 44.7 (95% CI: 38.8–50.5). Patients were categorized in groups according to time interval from NACT to IDS (< 4 weeks (group A); 4–5 weeks (group B); 5–6 weeks (group C); >6 weeks (group D). Patients with a time interval IDS to NACT ≥ 4 weeks had significantly shorter PFS (p = 0.004) and OS (p = 0.002). Median PFS was 26.6 months (95% CI: 24–29.2) for patients undergoing IDS < 4 weeks after NACT versus 14.4 months (95% CI: 12.6–16.2) for those undergoing IDS later (p = 0.004). Accordingly, median OS was 66.3 months (95% CI: 39.1–93.4) versus 39.4 months (95% CI: 31.8–47.0) in the < 4 week versus > 4 week time interval NACT to IDS groups (p = 0.002). On multivariate analysis, short time interval (< 4 weeks) from NACT to IDS was an independent factor of PFS (p = 0.004) and OS (p = 0.003). CONCLUSION We have demonstrated that performing IDS within 4 weeks after NACT may be associated with better survival outcomes. Multidisciplinary coordination of ovarian cancer patients is required to avoid any unnecessary delays.

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Section: Discussionmentioning

confidence: 99%

Optimal Time Interval Between Neoadjuvant Platinum-based Chemotherapy and Interval Debulking Surgery in High-grade Serous Ovarian Cancer

Andrikopoulou

Liontos

Apostolidou

et al. 2022

Preprint

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“…Although heterogeneously defined and organized, all five found that waiting 8 weeks or more results in a higher rate of pCR without increase in postoperative complications or morbidity. 13,[47][48][49][50] Despite the number of observational studies, trial data, and meta-analyses, deciding the RSI remains controversial. The balance of contemporary literature supports that longer RSI is associated with higher rates of pCR.…”

Section: Question 1: Does a Longer Rsi Improve Rates Of Pcr And Does ...mentioning

confidence: 99%

“…19,21,[44][45][46]71 Four meta-analyses concluded that there was no difference in perioperative complications despite a longer RSI. 13,[47][48][49] Acknowledging the relatively small differences between short and long RSI in the published literature raises many questions when this data are extrapolated to nonoperative W&W programs where patients may fail months-to-years after radiation. Meyer et al reported results from a retrospective observational study of 94 patients who received nCRT and either immediate proctectomy (n = 65; RSI = 16 weeks) or salvage proctectomy after being enrolled in a W&W program (n = 29; RSI = 41 weeks).…”

Section: Question 2: Do Increased Rates Of Pcr Translate To Improved ...mentioning

confidence: 99%

“…[1][2][3][4][5][6][7][8][9][10][11][12] Although various forms and courses of radiotherapy have been employed to treat rectal cancer for over 50 years, characterizing the optimal total dose, treatment course, and subsequent timing to oncological proctectomy remains contentious. 7,13 Moreover, recently popularized "total" neoadjuvant chemoradiotherapy (TNT) and nonoperative "watch and wait" (W&W) protocols add more variables to a complex and partially defined equation and often add substantial time to the interval between completing radiotherapy and surgical resection. 5,[14][15][16][17] Altering the radiation-surgery interval (RSI) offers a series of hypothetical trade-offs for patients requiring proctectomy following radiation.…”

Section: Introductionmentioning

confidence: 99%

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Determining the optimal radiation‐surgery interval (RSI) for oncologic proctectomy following radiotherapy for rectal adenocarcinoma

Bobel

McGee

2023

Journal of Surgical Oncology

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Preoperative radiotherapy has improved outcomes in rectal cancer patients, however, the optimal interval between radiation and proctectomy is unknown. A review of contemporary literature suggests an 8–12 week interval between radiation and surgery likely improves tumor response rates for rectal cancer patients undergoing proctectomy, which may convey modest improvements in long‐term oncologic outcomes. Prolonged radiation‐surgery intervals may expose surgeons to pelvic fibrosis, however, which may impact later‐term proctectomies and compromise perioperative and oncologic outcomes.

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“…The optimal time interval for response assessment is highly debated. For non-TNT approaches, there is increasing evidence that longer time intervals after (chemo)radiation (>8 weeks) may increase the likelihood of pCR without facing higher postsurgical morbidity [ 50 , 51 ]. In contrast, a randomized trial specifically addressing this issue by comparing surgery after 7 weeks with 11 weeks from the end of neoadjuvant CRT failed to show any benefit from a longer waiting time with regard to pCR rates, but reported detrimental effects on postoperative morbidity [ 52 ].…”

Section: Response Assessmentmentioning

confidence: 99%

How We Treat Localized Rectal Cancer—An Institutional Paradigm for Total Neoadjuvant Therapy

Roeder

Gerum

Hecht

et al. 2022

Cancers

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Total neoadjuvant therapy (TNT)—the neoadjuvant employment of radiotherapy (RT) or chemoradiation (CRT) as well as chemotherapy (CHT) before surgery—may lead to increased pathological complete response (pCR) rates as well as a reduction in the risk of distant metastases in locally advanced rectal cancer. Furthermore, increased response rates may allow organ-sparing strategies in a growing number of patients with low rectal cancer and upfront immunotherapy has shown very promising early results in patients with microsatellite instability (MSI)-high/mismatch-repair-deficient (dMMR) tumors. Despite the lack of a generally accepted treatment standard, we strongly believe that existing data is sufficient to adopt the concept of TNT and immunotherapy in clinical practice. The treatment algorithm presented in the following is based on our interpretation of the current data and should serve as a practical guide for treating physicians—without any claim to general validity.

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Does a long interval between neoadjuvant chemoradiotherapy and surgery benefit the clinical outcomes of locally advanced rectal cancer? A systematic review and meta analyses

Cited by 13 publications

References 44 publications

Optimal Time Interval Between Neoadjuvant Platinum-based Chemotherapy and Interval Debulking Surgery in High-grade Serous Ovarian Cancer

Optimal Time Interval Between Neoadjuvant Platinum-based Chemotherapy and Interval Debulking Surgery in High-grade Serous Ovarian Cancer

Determining the optimal radiation‐surgery interval (RSI) for oncologic proctectomy following radiotherapy for rectal adenocarcinoma

How We Treat Localized Rectal Cancer—An Institutional Paradigm for Total Neoadjuvant Therapy

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