Total Neoadjuvant Therapy in Rectal Cancer

医学 新辅助治疗 诱导化疗 内科学 结直肠癌 放化疗 肿瘤科 科克伦图书馆 优势比 化疗 随机对照试验 外科 癌症 乳腺癌
作者
Fausto Petrelli,Francesca Trevisan,Mary Cabiddu,Giovanni Sgroi,Lorenza Bruschieri,Emanuele Rausa,Michele Ghidini,Luca Turati
出处
期刊:Annals of Surgery [Ovid Technologies (Wolters Kluwer)]
卷期号:271 (3): 440-448 被引量:276
标识
DOI:10.1097/sla.0000000000003471
摘要

Background: The addition of induction chemotherapy to concomitant neoadjuvant chemoradiation in locally advanced rectal cancer could increase pathological downstaging and act on occult micrometastatic disease, leading ultimately to a better outcome. A systematic review was carried out of the existing literature on the treatment outcomes of total neoadjuvant therapy (TNT) on locally advanced rectal cancer. TNT was defined as chemotherapy using cycles of induction and/or consolidation in conjunction with standard chemoradiotherapy prior to surgery. Methods: A systematic search of PubMed, Embase, and the Cochrane Library was performed according to the PRISMA statement up until January 2019. The primary endpoints were complete pathologic response (pCR), disease-free survival, and overall survival rates. Results: A total of 28 studies (3 retrospective and 25 prospective for a total of 3579 patients) were included in the final analysis (n = 2688 treated with TNT and n = 891 with neoadjuvant chemoradiotherapy therapy). The pooled pCR rate was 22.4% (95% CI 19.4%–25.7%) in all patients treated with TNT (n = 27 studies with data available). In n = 10 comparative studies with data available, TNT was found to increase the odds of pCR by 39% (1.40, 95% CI 1.08–1.81, P = 0.01). Conclusions: The addition of induction or consolidation chemotherapy to standard neoadjuvant chemoradiotherapy results in a higher pCR rate. Given that the comparative analysis was derived from few randomized publications, large confirmatory trials should be carried out before a strong recommendation is made in favor of TNT.
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