Neoadjuvant treatments for resectable rectal cancer: A network meta‑analysis

Zhong, Wei; Xue, Xiao-Jun; Dai, Lianzhi; Li, Ranran; Nie, Kai; Zhou, Song

doi:10.3892/etm.2020.8494

Cited by 3 publications

(4 citation statements)

References 57 publications

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“…North European guidelines recommend short-course radiotherapy (SCRT), 25 Gy in 5 fractions, followed by total mesorectal excision (TME) surgery for intermediate risk rectal cancer [1][2][3]. The addition of SCRT to TME surgery in this patient group reduces the risk of local recurrences compared to TME surgery alone [3,4]. In addition, the Stockholm III trial showed fewer postoperative complications after a prolonged interval between SCRT and TME compared to direct surgery after SCRT [5].…”

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confidence: 99%

Planning target volume margin assessment for online adaptive MR-guided dose-escalation in rectal cancer on a 1.5 T MR-Linac

Eijkelenkamp

Boekhoff

Verweij

et al. 2021

Radiotherapy and Oncology

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This study assessed the margins needed to cover tumor intrafraction motion during an MRguided radiotherapy (MRgRT) dose-escalation strategy in intermediate risk rectal cancer. Methods: Fifteen patients with rectal cancer were treated with neoadjuvant short-course radiotherapy, 5x5 Gy, according to an online adaptive workflow on a 1.5 T MR-linac. Per patient, 26 3D T2 weighted MRIs were made; one reference scan preceding treatment and five scans per treatment fraction. The primary tumor was delineated on each scan as gross tumor volume (GTV). Target coverage margins were assessed by isotropically expanding the reference GTV until more than 95% of the voxels of the sequential GTVs were covered. A margin with a coverage probability threshold of 90% was defined as adequate. Intra-and interfraction margins to cope with the movement of the GTV in the period between scans were calculated to indicate the target volume margins. Furthermore, the margin needed to cover GTV movement was calculated for different time intervals. Results: The required margins to cover inter-and intrafraction GTV motion were 17 mm and 6 mm, respectively. Analysis based on time intervals between scans showed smaller margins were needed for adequate GTV coverage as time intervals became shorter, with a 4 mm margin required for a procedure of 15 min or less. Conclusion:The shorter the treatment time, the smaller the margins needed to cover for the GTV movement during an online adaptive MRgRT dose-escalation strategy for intermediate risk rectal cancer. When time intervals between replanning and the end of dose delivery could be reduced to 15 min, a 4 mm margin would allow adequate target coverage.

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confidence: 99%

Planning target volume margin assessment for online adaptive MR-guided dose-escalation in rectal cancer on a 1.5 T MR-Linac

Eijkelenkamp

Boekhoff

Verweij

et al. 2021

Radiotherapy and Oncology

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“…This outcome may indicate that the local control power of NAC without radiotherapy may be insufficient. In fact, Zhong et al reported that NACRT was more effective than NAC in terms of local recurrence [24]. However, the histopathological characteristics of the patients with R1 operation were poorly differentiated adenocarcinoma (por) in two of the three patients and mucinous adenocarcinoma (muc) in one of the three patients.…”

Section: Discussionmentioning

confidence: 97%

Feasibility and Efficacy of Neoadjuvant Chemotherapy without Radiotherapy for Locally Advanced Rectal Cancer

Tokuhara

Matsui

Ueyama

et al. 2022

J Anus Rectum Colon

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Objectives: This retrospective study explored the feasibility of neoadjuvant chemotherapy (NAC) without radiotherapy in patients with locally advanced rectal cancer (LARC). Methods: Patients with clinical stage of T3-T4 and/or N-positive LARC patients were included. We retrospectively analyzed patients' NAC-related and perioperative outcomes. Results:The study enrolled 30 patients. mFOLFOX6 or SOX plus cetuximab was administered to 12 patients with the wild-type RAS gene and FOLFOXIRI or SOXIRI to 18 patients with mutant-type RAS. The NAC completion rate was 90.0%. All patients underwent total mesorectal excision, and 29 patients underwent combined bilateral lateral lymph node dissection. The R0 operation rate was 90.0%. Although the postoperative complication rate was 40%, no complications were associated with NAC. The response rate of NAC and the proportion of histological anti-tumor effect grade !2 were 56.7% and 46.7%, respectively. Conclusions: NAC was considered to be a safe, feasible treatment option for LARC.

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“…Because the exact relationship between PLR and the OS and DFS of patients receiving NAC is yet unknown, we conducted a meta-analysis to determine the relevant relationships. In some cases, the addition of NAC resulted in greater tumor downsizing and increasing the rate of complete resection, improved the pCR rate, and demonstrated local control, but the relative effects are controversial [38–45] . To the best of our knowledge, meta-analyses are a more comprehensive update that systematically and quantitatively evaluates this topic.…”

Section: Discussionmentioning

confidence: 99%

“…In some cases, the addition of NAC resulted in greater tumor downsizing and increasing the rate of complete resection, improved the pCR rate, and demonstrated local control, but the relative effects are controversial. [38][39][40][41][42][43][44][45] To the best of our knowledge, meta-analyses are a more comprehensive update that systematically and quantitatively evaluates this topic. In the present meta-analysis of 18 studies including 3653 cases, we evaluated the prognostic role of PLR in solid tumors following NAC or nCRT.…”

Section: Discussionmentioning

confidence: 99%

Prognostic value of platelet-to-lymphocyte ratio in neoadjuvant chemotherapy for solid tumors

Long

Zhang²,

Ni³

et al. 2021

Medicine

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Introduction: Previous research indicates that the platelet-to-lymphocyte ratio (PLR) may be an indicator of poor prognosis in many tumor types. However, the PLR is rarely described in patients undergoing neoadjuvant chemotherapy (NAC) for solid tumors. Thus, we performed a meta-analysis to investigate the prognostic value of this ratio for patients with solid tumors treated by NAC.Methods: A comprehensive search of the literature was conducted using the PubMed, EMBASE, Cochrane Library, and Web of Science databases, followed by a manual search of references from the retrieved articles. Pooled hazard ratios (HRs) with 95% confidence interval (CIs) were used to evaluate the association between PLR and 3 outcomes, namely, overall survival, disease-free survival, and pathological complete response rate after NAC.Results: Eighteen studies published no earlier than 2014 were included in our study. A lower PLR was associated with better overall survival (HR = 1.46, 95% CI, 1.11-1.92) and favorable disease-free survival (HR = 1.81, 95% CI, 1.27-2.59). A PLR that was higher than a certain cutoff was associated with a lower pathological complete response rate in patients with cancer who received NAC (Odds ratio = 1.93, 95% CI, 1.40-2.87).Conclusion: Elevated PLR is associated with poor prognosis in various solid tumors. PLR may be a useful biomarker in delineating those patients with poorer prognoses who may benefit from neoadjuvant therapies.Abbreviations: CI = confidence interval, DFS = disease-free survival, HR = hazard ratio, NOS = Newcastle-Ottawa Scale, OR = odds ratio, OS = overall survival, PFS = progression-free survival, PLR = platelet-to-lymphocyte ratio, NAC = neoadjuvant chemotherapy, nCRT = neoadjuvant chemoradiotherapy, pCR = pathological complete response, ROC = receiver operating characteristic curve.

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Neoadjuvant treatments for resectable rectal cancer: A network meta‑analysis

Cited by 3 publications

References 57 publications

Planning target volume margin assessment for online adaptive MR-guided dose-escalation in rectal cancer on a 1.5 T MR-Linac

Planning target volume margin assessment for online adaptive MR-guided dose-escalation in rectal cancer on a 1.5 T MR-Linac

Feasibility and Efficacy of Neoadjuvant Chemotherapy without Radiotherapy for Locally Advanced Rectal Cancer

Prognostic value of platelet-to-lymphocyte ratio in neoadjuvant chemotherapy for solid tumors

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