Treatment of High Rectal Cancers: Do We Need Radiation?

Saeed, Nadia; Hoffe, Sarah E.; Frakes, Jessica M.

doi:10.1007/s11888-016-0333-6

Cited by 1 publication

(1 citation statement)

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“…This raises the question of whether these results may apply to patients with upper rectal cancer, as data on this particular tumor site are scarce. Moreover, the use of radiotherapy in this subset of patients has been questioned over the past years, since locoregional recurrence rates with TME alone are low and significant toxicity is associated with this additional treatment [23,24]. In fact, in the seminal German Rectal Cancer trial, while local recurrence at 5 years was 10.1% in low-third LARC, it was only 2.7% for tumors located > 10 cm from the anal verge [25].…”

Section: Discussionmentioning

confidence: 99%

Impact of Total Neoadjuvant Therapy vs. Standard Chemoradiotherapy in Locally Advanced Rectal Cancer: A Systematic Review and Meta-Analysis of Randomized Trials

Martínez

Fernández-Martos

Gravalos-Castro

et al. 2020

Cancers

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Multimodality treatment is a standard of care for LARC, but the optimal sequencing of the treatment modalities remains unclear. Several randomized clinical trials (RCTs) compared total neoadjuvant treatment (TNT) vs. standard neoadjuvant chemoradiotherapy (CRT) with inconsistent results. A systematic review and meta-analysis was performed to evaluate the efficacy of TNT in terms of complete pathological response (pCR) rate, disease-free and overall survival vs. standard CRT in LARC. A systematic search was performed through MEDLINE, EMBASE, Cochrane Central Register of Controlled Trials and meeting abstracts up to May 2020. RCTs comparing CRT vs. TNT followed by surgery in LARC were eligible for the study. Study selection and data extraction were done following PRISMA guidelines by two independent reviewers. The Mantel–Haenzel method was used to obtain a fixed-effects model of pooled odds or hazard ratios for the main outcomes. Eight RCTs, including 2301 patients, met the eligibility criteria. TNT significantly improved pCR rate (OR = 1.99, 95% confidence interval (CI) 1.59–2.49; p < 0.001), 3-year disease-free-survival (DFS) (HR = 0.82, 95%CI 0.71–0.95; p = 0.01) and 3-year overall survival (OS) (hazard ratio (HR) = 0.81, p = 0.04). Grade 3–4 adverse events were not significantly different in both strategies (OR = 1.58; p = 0.14). An improved pCR rate was documented regardless of the type of radiotherapy administered (long vs. short fractionation schedules). No significant heterogeneity was found. The results of this meta-analysis show that TNT improves pCR and survival rates vs. standard preoperative CRT in patients with LARC. TNT may become a new standard of care in LARC, although longer follow-up is needed to properly assess its long-term impact on survival.

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Section: Discussionmentioning

confidence: 99%