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Why intensify the neo-adjuvant approach with chemotherapy and radiotherapy in rectal cancer? A Systematic review and meta-analysis

Article scientifique 2023 Anglais

Résumé

Abstract Background & Aims: Despite optimal local control, chemoradiotherapy (CRT) data on overall and disease-free survival are still equivocal. This meta-analysis aimed to estimate the pathological complete response (pCR), regression rate, disease-free survival and overall survival probabilities of rectal cancer patients treated with intensified chemotherapy. Data sources: Computerised bibliographic searches of MEDLINE and Cochrane Central Register of Controlled Trials databases (1970-2023) were supplemented with hand searches of reference lists. Study selection: Studies were included if they were randomised controlled trials (RCTs) comparing intensified chemotherapy with CRT to preoperative CRT and if they had patients with resectable, histologically-proven, rectal adenocarcinoma without metastases. Eighteen RCTs (7695 patients) were analysed. Data extraction: Data on population, intervention, and outcomes were extracted from each RCT, following the intention-to-treat method, by three independent observers and combined using the DerSimonian and Laird methods. Results: Intensified chemotherapy and CRT, compared to preoperative CRT, significantly increases the rate of pathological complete response (OR 1.37 (95% CI, 1.16-1.63) p=0.0003) and the regression rate (OR 1.57 (95% CI, 1.16-2.14) p < 0.00001). Furthermore, it increases disease-free survival HR 0.87 (95% CI, 0.79 to 0.95) p=0.002 and overall survival HR 0.84 (95% CI, 0.74 to 0.95) p= 0.007. Finally, the risk of therapy to severe adverse events (≥G3) is increased OR 1.96 (95% CI 1.35–2.85), p =0.0005. Conclusions: In patients with resectable rectal cancer, intensified chemotherapy can reduce by 13% the hazard of disease progression and by 16% the hazard of death.

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Tebano, U., Mandarà, M., Giuliani, J., Franceschetto, A., Giorgi, C., Missiroli, S., Gabbani, M., Zaninelli, M., Napoli, G., Luca, N., Mangiola, D., Muraro, M., Visentin, S., Perrone, M., Pinton, P., Fiorica, F. (2023). Why intensify the neo-adjuvant approach with chemotherapy and radiotherapy in rectal cancer? A Systematic review and meta-analysis. https://doi.org/10.21203/rs.3.rs-3317777/v1

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Auteur(s)

Umberto Tebano Marta Mandarà Jacopo Giuliani Antonella Franceschetto Carlotta Giorgi Sonia Missiroli Milena Gabbani Marta Zaninelli Giuseppe Napoli Nicoletta Luca Daniela Mangiola Marco Muraro S. Visentin Mariasole Perrone Paolo Pinton Francesco Fiorica

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