Neoadjuvant Short-Course Radiotherapy Followed by Consolidation Chemotherapy before Surgery for Treating Locally Advanced Rectal Cancer: A Systematic Review and Meta-Analysis

Liao, Chun-Kai; Kuo, Ya-Ting; Lin, Yueh‐Chen; Chern, Yih-Jong; Hsu, Yu-Jen; Yu, Yen-Lin; Chiang, Jy-Ming; Hsieh, Pao-Shiu; Yeh, Chien-Yuh; You, Jeng-Fu

doi:10.3390/curroncol29050297

Cited by 13 publications

(7 citation statements)

References 51 publications

(89 reference statements)

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“…Studies have demonstrated the benefit of SCRT for the reduction of local recurrence rates and improving long-term outcomes as compared to surgery alone [26] , [27] . Other studies showed that SCRT results in tumor downstaging and in some cases even in a clinical or pathological complete response after delayed surgery [9] , [12] , [28] , [29] . This has expanded the eligibility for organ-preserving treatment, aiming to maintain rectal function while effectively treating the cancer, enhancing a better QoL [30] , [31] .…”

Section: Discussionmentioning

confidence: 98%

Quality of life and clinical outcomes in rectal cancer patients treated on a 1.5T MR-Linac within the MOMENTUM study

Daamen,

Westerhoff,

Couwenberg

et al. 2024

Clinical and Translational Radiation Oncology

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Section: Discussionmentioning

confidence: 98%

Quality of life and clinical outcomes in rectal cancer patients treated on a 1.5T MR-Linac within the MOMENTUM study

Daamen,

Westerhoff,

Couwenberg

et al. 2024

Clinical and Translational Radiation Oncology

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“…As regards the chemotherapy duration, we adopted four cycles of mFOLFOX6 because the ypCR rate was as low as 11% with SCRT followed by three cycles of mFOLFOX6 in our initial experience [33]. Meta-analysis of 17 studies comparing SCRT followed by consolidation chemotherapy with CRT supports using at least four cycles of consolidation chemotherapy following SCRT to achieve improved ypCR and DFS over preoperative CRT alone [34]. Because SCRT followed by four cycles of CAPOX achieved signi cantly higher ypCR rate and 3-year OS than CRT alone in the STELLAR trial [5] involving patients with cT3-4 or cN+, the results of this SOLAR trial are awaited.…”

Section: Discussionmentioning

confidence: 99%

Preoperative sequential short-course radiation therapy and FOLFOX chemotherapy versus long-course chemoradiotherapy for locally advanced rectal cancer: A multicenter, randomized controlled trial (SOLAR trial)

Kang,

Yeun,

Park

et al. 2023

Preprint

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Background Preoperative (chemo)radiotherapy has been widely used as an effective treatment for locally advanced rectal cancer (LARC), leading to a significant reduction in pelvic recurrence rates. Because early administration of intensive chemotherapy for LARC has more advantages than adjuvant chemotherapy, total neoadjuvant therapy (TNT) has been introduced and evaluated to determine whether it can improve tumor response or treatment outcomes. This study aims to investigate whether short-course radiotherapy (SCRT) followed by intensive chemotherapy improves oncologic outcomes compared with traditional preoperative long-course chemoradiotherapy (CRT).Methods A multicenter randomized phase II trial involving 364 patients with LARC (cT3–4, cN+, or presence of extramural vascular invasion) will be conducted. Patients will be randomly assigned to the experimental or control arm at a ratio of 1:1. Participants in the experimental arm will receive SCRT (25 Gy in 5 fractions, daily) followed by four cycles of FOLFOX (oxaliplatin, 5-fluorouracil, and folinic acid) as a neoadjuvant treatment, and those in the control arm will receive conventional radiotherapy (45−50.4 Gy in 25−28 fractions, 5 times a week) concurrently with capecitabine or 5-fluorouracil. As a mandatory surgical procedure, total mesorectal excision will be performed 2–5 weeks from the last cycle of chemotherapy in the experimental arm and 6–8 weeks after the last day of radiotherapy in the control arm. The primary endpoint is 3-year disease-free survival, and the secondary endpoints are tumor response, overall survival, toxicities, quality of life, and cost-effectiveness.Discussion This is the first Korean randomized controlled study comparing TNT with traditional preoperative LC-CRT for LARC. The involvement of experienced colorectal surgeons ensures high-quality surgical resection. SCRT followed by FOLFOX chemotherapy is expected to improve disease-free survival compared with CRT, with potential advantages in tumor response, quality of life, and cost-effectiveness.Trial registration This trial is registered at Clinical Research Information under the identifier Service KCT0004874 on April 02, 2020, and at Clinicaltrial.gov under the identifier NCT05673772 on January 06, 2023.

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“…They demonstrated that employing this method increased sphincter preservation surgery, improved PCR rates, and the proportion of ypN0 status from initially involved regional nodes. The longer time between RT and surgery, during which systemic chemotherapy was administered, may have contributed to the increased PCR rate (12) .…”

Section: Discussionmentioning

confidence: 99%

“…In addition, the combined outcomes of this meta-analysis revealed that the PCR rate in group who received SCRT followed by delayed surgery without consolidation chemotherapy was much lower than that of traditional CRT. Thus, in the treatment of LARC, conventional CRT cannot be substituted with merely prolonging the time between SCRT and surgery in the absence of consolidation chemotherapy (12) .…”

Section: Discussionmentioning

confidence: 99%

Preoperative Short-Course Radiotherapy with Delayed Surgery Versus Long-Course Chemoradiotherapy for Locally Advanced Rectal Cancer

2023

The Egyptian Journal of Hospital Medicine

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Background: In multiple studies, preoperative long-course radiotherapy (PLRT) in conjunction with concurrent chemotherapy (PLCRT) and preoperative short-course radiotherapy (PSRT) with immediate surgery have demonstrated comparable outcomes regarding late morbidity, local control, and prolonged survival. However, long-course RT demonstrated a more favorable pathological complete response (PCR). The acute radiation toxicities associated with the short-course program are considerably lower than those observed in standard CRT. Significant benefits are associated with postponing surgery after neoadjuvant therapy for rectal cancer. As a result, a strategy of short-course RT and then consolidation chemotherapy prior to surgical resection is developed to achieve these benefits.Objective: This study aimed to evaluate the treatment outcome, safety, and feasibility of preoperative short-course hypo fractionated RT (SCRT) followed by chemotherapy versus standard conventional long-course concurrent chemoradiotherapy (LCRT) for locally advanced rectal cancer (LARC) patients. Patients and methods: This phase II prospective trial included 59 patients through the period from May 2020 to February 2021 in Sohag Cancer Center and Sohag University Hospital with a median follow-up of 31 months (range 4:37). Thirty cases were assigned to the experimental group (SCRT) and twenty-nine were assigned to the standard group (LCRT). The study was performed on locally advanced rectal cancer (LARC) cases and were randomized to neoadjuvant short-course RT followed by chemotherapy or preoperative conventional long-course CRT. Pathological response and treatment-related toxicity constituted the main endpoints. EFS, LFFS, DRFS, and OS were the secondary endpoints. Results: No significant variations were reported between the SCRT and LCRT groups as regards death rate and locoregional failure rate, or distant recurrence. In subgroup analysis for cases who were subjected to resection, no significant variations were reported between the SCRT and LCRT groups regarding postoperative (pathological) stages, pathological complete response rates, and grades of tumors. No significant variation was reported between the two groups as regards most of treatment-related toxicities, but the SCRT group had significantly lower radiation therapyinduced toxicities than the LCRT group. Conclusion: Patients diagnosed with LARC may benefit from SCRT followed by chemotherapy as a substitute for conventional CRT. SCRT with delayed surgery showed comparable efficacy to conventional LCRT.

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Neoadjuvant Short-Course Radiotherapy Followed by Consolidation Chemotherapy before Surgery for Treating Locally Advanced Rectal Cancer: A Systematic Review and Meta-Analysis

Cited by 13 publications

References 51 publications

Quality of life and clinical outcomes in rectal cancer patients treated on a 1.5T MR-Linac within the MOMENTUM study

Quality of life and clinical outcomes in rectal cancer patients treated on a 1.5T MR-Linac within the MOMENTUM study

Preoperative sequential short-course radiation therapy and FOLFOX chemotherapy versus long-course chemoradiotherapy for locally advanced rectal cancer: A multicenter, randomized controlled trial (SOLAR trial)

Preoperative Short-Course Radiotherapy with Delayed Surgery Versus Long-Course Chemoradiotherapy for Locally Advanced Rectal Cancer

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