Efficacy and safety of total neoadjuvant therapy in locally advanced rectal cancer: a meta-analysis

Xiong, Kai; Bao, Tiantian; Cao, Yibo; Hu, Wenting; Deng, Jia; Jiang, Chen; Xiao, Tianbao

doi:10.1007/s00384-023-04376-y

Cited by 7 publications

(4 citation statements)

References 36 publications

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“…The reduction of distant metastasis is attributed to the early treatment of micrometastasis with TNT 34 . Indeed, oncological results from TNT have been promising, with RCTs as well as multiple meta-analyses on the topic showing statistically significant improvement in pathologic complete response rates and disease-free survival 11–14 . TNT has also shown no difference in R0 resection rates and treatment toxicity in these analyses, and this has led some authors to conclude that TNT should be considered the new standard of care in the multimodal treatment of rectal cancers 35…”

Section: Discussionmentioning

confidence: 99%

“…3 However, the reporting of the effect of TNT on surgery is not standardized in the published studies, and consequently the current meta-analyses have reported it only as a binary event. [11][12][13][14] In view of the recent publication on the 5-year followup of RAPIDO reporting higher local recurrence rates (10% vs 6%) related to higher rates of breached TME (21% vs 4%) in TNT patients, 15 there has been considerable interest in the effect of TNT on surgical outcomes. The aim of this study is to compare data from all high quality RCTs on TNT versus LCRT, to provide data on these unanswered questions concerning implications of TNT on surgical outcomes.…”

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confidence: 99%

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Surgical Outcomes in Total Neoadjuvant Therapy for Rectal Cancer Versus Standard Long-course Chemoradiation

Lin,

Li,

Clement

et al. 2023

Annals of Surgery

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Objective: This systematic review and meta-analysis seeks to evaluate the impact of total neoadjuvant therapy (TNT) for rectal cancers on surgical complications and surgical pathology when compared to standard long course chemoradiotherapy (LCRT). Background: The oncological benefits of TNT are well published in previous meta-analyses, but there is little synthesized information on how it affects surgical outcomes. A recent study has suggested an increase in local recurrence and higher rates of breached total mesorectal excision (TME) plane in TNT patients. Methods: This study conformed to the PRISMA guidelines. A search was performed in Medline (via PubMed), Cochrane databases, EMBASE and CINAHL to identify relevant randomized controlled trials (RCTs) comparing outcomes between TNT and LCRT. Meta-analyses of pooled proportions between TNT and LCRT were performed, comparing primary outcomes of surgical mortality, morbidity and all reported complications; surgical-pathology differences, namely mesorectal quality, R0 resection rates, circumferential resection margin (CRM) positive rates and sphincter preservation rates. Death and progression of disease during neoadjuvant treatment period was also compared. Risk of bias of RCTs was performed using the Cochrane risk-of-bias tool by 2 independent reviewers. Results: A total of 3185 patients with rectal cancer from 11 RCTs were included in the analysis: 1607 received TNT and 1578 received LCRT, of which 1422 (TNT arm) and 1391 (LCRT arm) underwent surgical resection with curative intent. There was no significant difference in mortality (RR 0.86, 95% CI 0.13 – 5.52, P=0.88, I2=52%)) or major complications (RR 1.04, 95% CI 0.86-1.26, P=0.70, I2=0%) between TNT and LCRT. There was a significantly higher risk of breached TME in TNT group on pooled analysis (RR 1.49, 95% CI 1.03-12.16, P=0.03, I2=0%), and on subgroup analysis there is higher risk of breached TME in those receiving extended duration of neoadjuvant treatment (>17 wk from start of treatment to surgery) when compared to LCRT (RR 1.61, 95% CI 1.06-2.44, P=0.03). No difference in R0 resection rates (RR 0.85, 95% CI 0.66-1.10, P=0.21, I2=15%), CRM positive rates (RR 0.87, 95% CI 0.65-1.16, P=0.35, I2=10%) or sphincter preservation rates (RR 1.02, 95% CI 0.83-1.25, P=0.88, I2=57%) were observed. There was a significantly lower risk of progression of disease to an unresectable stage during the neoadjuvant treatment period in TNT patients (RR 0.60, 95% CI 0.39-0.92, P=0.03, I2=18%). On subgroup analysis it appears to favour those receiving extended duration of neoadjuvant treatment (RR 0.44, 95% CI 0.26-0.80, P=0.002), and those receiving induction-type chemotherapy in TNT (RR 0.25, 95% CI 0.07-0.88, P=0.03). Conclusion: TNT increases rates of breached TME which can contribute to higher local recurrence rates. TNT, however, improves systemic control by reducing early progression of disease during neoadjuvant treatment period. Further research is warranted to identify patients that will benefit from this strategy.

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Section: Discussionmentioning

confidence: 99%

mentioning

confidence: 99%

Surgical Outcomes in Total Neoadjuvant Therapy for Rectal Cancer Versus Standard Long-course Chemoradiation

Lin,

Li,

Clement

et al. 2023

Annals of Surgery

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“…We have read with interest the article published by Bedrikovetski S et al 1 After total neoadjuvant therapy (TNT) for rectal cancer, overall complete response (oCR) can bring better oncological outcomes to patients, which is related to reducing local recurrence rate and improving disease-free survival rate. 2,3 A study shows that the 5-year survival rate of rectal cancer after TNT is as high as 90%, and the local recurrence rate is only 1.7%, indicating that patients who achieve oCR after TNT have better long-term survival rate. 4 Therefore, searching for clinical factors that predict oCR can help determine the prognosis of rectal cancer and the selection of individualized treatment plans.…”

Section: To the Editorsmentioning

confidence: 99%

Can sarcopenia predict complete response after total neoadjuvant therapy in advanced rectal cancer?

Yang¹,

2023

Journal of Surgical Oncology

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“…Locally advanced rectal cancer patients with T3‐4, negative/positive lymph nodes, and no distant metastases are recommended to undergo preoperative chemoradiotherapy followed by radical resection. This combination of treatments has been linked to established advantages, including tumor down‐staging and down‐sizing (Bosset et al, 2014; Boublikova et al, 2023; Dapra et al, 2023; Koukourakis et al, 2023; van Gijn et al, 2011; Xiong et al, 2023). Although multimodal therapy has significantly decreased the local recurrence rate, this has not significantly reduced the risk of distant metastatic recurrence, which is now the primary cause of death from rectal cancer (Gollins & Sebag‐Montefiore, 2016; Lord et al, 2020; Sebag‐Montefiore et al, 2009).…”

Section: Introductionmentioning

confidence: 99%

Prediction of liver metastasis and recommended optimal follow‐up nursing in rectal cancer

Yu,

Wu,

et al. 2024

Nursing & Health Sciences

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We aimed to analyze and investigate the clinical factors that influence the occurrence of liver metastasis in locally advanced rectal cancer patients, with an attempt to assist patients in devising the optimal imaging‐based follow‐up nursing. Between June 2011 and May 2021, patients with rectal cancer at our hospital were retrospectively analyzed. A random survival forest model was developed to predict the probability of liver metastasis and provide a practical risk‐based approach to surveillance. The results indicated that age, perineural invasion, and tumor deposit were significant factors associated with the liver metastasis and survival. The liver metastasis risk of the low‐risk group was higher at 6–21 months, with a peak occurrence time in the 15th month. The liver metastasis risk of the high‐risk group was higher at 0–24 months, with a peak occurrence time in the 8th month. In general, our clinical model could predict liver metastasis in rectal cancer patients. It provides a visualization tool that can aid physicians and nurses in making clinical decisions, by detecting the probability of liver metastasis.

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Efficacy and safety of total neoadjuvant therapy in locally advanced rectal cancer: a meta-analysis

Cited by 7 publications

References 36 publications

Surgical Outcomes in Total Neoadjuvant Therapy for Rectal Cancer Versus Standard Long-course Chemoradiation

Surgical Outcomes in Total Neoadjuvant Therapy for Rectal Cancer Versus Standard Long-course Chemoradiation

Can sarcopenia predict complete response after total neoadjuvant therapy in advanced rectal cancer?

Prediction of liver metastasis and recommended optimal follow‐up nursing in rectal cancer

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