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Effect of Interval between Neoadjuvant Chemoradiotherapy and Surgery on Oncological Outcome for Rectal Cancer: A Systematic Review and Meta-Analysis.

Wang XJ, Zheng ZR, Chi P, Lin HM, Lu XR, Huang Y - Gastroenterol Res Pract (2016)

Bottom Line: Conclusion.Performing surgery 7-8 weeks after the end of NCRT results in the highest chance of achieving pCR.For candidates of abdominoperineal resection before NCRT, these data support implementation of prolonging the interval after NCRT to optimize the chances of pCR and perhaps add to the possibility of ultimate organ preservation.

View Article: PubMed Central - PubMed

Affiliation: Department of Colorectal Surgery, Union Hospital, Fujian Medical University, Fuzhou, Fujian 350001, China.

ABSTRACT
Aim. To evaluate the influence of interval between neoadjuvant chemoradiotherapy (NCRT) and surgery on oncological outcome. Methods. A systematic search was conducted in PubMed, the Cochrane Library, and Embase databases for publications reporting oncological outcomes of patients following rectal cancer surgery performed at different NCRT-surgery intervals. Relative risk (RR) of pathological complete response (pCR) among different intervals was pooled. Results. Fifteen retrospective cohort studies representing 4431 patients met the inclusion criteria. There was a significantly increased rate of pCR in patients treated with surgery followed 7 or 8 weeks later (RR, 1.45; 95% CI, 1.18-1.78; and P < 0.01 and RR, 1.49; 95% CI, 1.15-1.92; and P = 0.002, resp.). There is no consistent evidence of improved local control or overall survival with longer or shorter intervals. Conclusion. Performing surgery 7-8 weeks after the end of NCRT results in the highest chance of achieving pCR. For candidates of abdominoperineal resection before NCRT, these data support implementation of prolonging the interval after NCRT to optimize the chances of pCR and perhaps add to the possibility of ultimate organ preservation.

No MeSH data available.


Related in: MedlinePlus

Standard forest plot of the RR for pCR rates comparing longer time intervals with shorter intervals at 7 weeks.
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fig3: Standard forest plot of the RR for pCR rates comparing longer time intervals with shorter intervals at 7 weeks.

Mentions: The reported pCR rates ranged from 8.3% to 28.0% [6–20]. In order to determine the particular contribution of time intervals of NCRT-surgery to the occurrence of pCR, a meta-analysis was performed to calculate the RR associated with longer time intervals at beyond 5, 6, 7, 8, 10, or 12 weeks when compared to shorter intervals (Table 3, Figures 2–5). No heterogeneity was found among these studies included in the analysis (I2 < 50% each). Using a fixed-effect model, there was a significantly increased rate of pCR in patients treated with surgery followed 7 or 8 weeks later (RR, 1.45; 95% CI, 1.18–1.78; and P < 0.01 and RR, 1.49; 95% CI, 1.15–1.92; and P = 0.002). No significant differences were found between shorter and longer intervals cohorts with respect to rate of pCR in earlier cutoff points of 5 and 6 weeks (RR, 0.67; 95% CI, 0.40–1.12; and P = 0.13 and RR, 1.03; 95% CI, 0.76–1.42; and P = 0.83), and further extension beyond 10 or 12 weeks did not offer further advantages in increasing pCR rates (RR, 0.83; 95% CI, 0.65–1.06; and P = 0.13 and RR, 0.81; 95% CI, 0.60–1.08; and P = 0.15). Sensitivity analyses excluding data from Tulchinsky et al. [9] to control for patient with near-pCR did not alter the results substantially (RR, 1.39; 95% CI, 1.12 to 1.73; and P = 0.003). Data from Fang et al. [16] was also excluded for sensitivity analyses because of different definition of pCR, and result showed no change (RR, 1.09; 95% CI, 0.78 to 1.52; and P = 0.61).


Effect of Interval between Neoadjuvant Chemoradiotherapy and Surgery on Oncological Outcome for Rectal Cancer: A Systematic Review and Meta-Analysis.

Wang XJ, Zheng ZR, Chi P, Lin HM, Lu XR, Huang Y - Gastroenterol Res Pract (2016)

Standard forest plot of the RR for pCR rates comparing longer time intervals with shorter intervals at 7 weeks.
© Copyright Policy - open-access
Related In: Results  -  Collection

Show All Figures
getmorefigures.php?uid=PMC4829714&req=5

fig3: Standard forest plot of the RR for pCR rates comparing longer time intervals with shorter intervals at 7 weeks.
Mentions: The reported pCR rates ranged from 8.3% to 28.0% [6–20]. In order to determine the particular contribution of time intervals of NCRT-surgery to the occurrence of pCR, a meta-analysis was performed to calculate the RR associated with longer time intervals at beyond 5, 6, 7, 8, 10, or 12 weeks when compared to shorter intervals (Table 3, Figures 2–5). No heterogeneity was found among these studies included in the analysis (I2 < 50% each). Using a fixed-effect model, there was a significantly increased rate of pCR in patients treated with surgery followed 7 or 8 weeks later (RR, 1.45; 95% CI, 1.18–1.78; and P < 0.01 and RR, 1.49; 95% CI, 1.15–1.92; and P = 0.002). No significant differences were found between shorter and longer intervals cohorts with respect to rate of pCR in earlier cutoff points of 5 and 6 weeks (RR, 0.67; 95% CI, 0.40–1.12; and P = 0.13 and RR, 1.03; 95% CI, 0.76–1.42; and P = 0.83), and further extension beyond 10 or 12 weeks did not offer further advantages in increasing pCR rates (RR, 0.83; 95% CI, 0.65–1.06; and P = 0.13 and RR, 0.81; 95% CI, 0.60–1.08; and P = 0.15). Sensitivity analyses excluding data from Tulchinsky et al. [9] to control for patient with near-pCR did not alter the results substantially (RR, 1.39; 95% CI, 1.12 to 1.73; and P = 0.003). Data from Fang et al. [16] was also excluded for sensitivity analyses because of different definition of pCR, and result showed no change (RR, 1.09; 95% CI, 0.78 to 1.52; and P = 0.61).

Bottom Line: Conclusion.Performing surgery 7-8 weeks after the end of NCRT results in the highest chance of achieving pCR.For candidates of abdominoperineal resection before NCRT, these data support implementation of prolonging the interval after NCRT to optimize the chances of pCR and perhaps add to the possibility of ultimate organ preservation.

View Article: PubMed Central - PubMed

Affiliation: Department of Colorectal Surgery, Union Hospital, Fujian Medical University, Fuzhou, Fujian 350001, China.

ABSTRACT
Aim. To evaluate the influence of interval between neoadjuvant chemoradiotherapy (NCRT) and surgery on oncological outcome. Methods. A systematic search was conducted in PubMed, the Cochrane Library, and Embase databases for publications reporting oncological outcomes of patients following rectal cancer surgery performed at different NCRT-surgery intervals. Relative risk (RR) of pathological complete response (pCR) among different intervals was pooled. Results. Fifteen retrospective cohort studies representing 4431 patients met the inclusion criteria. There was a significantly increased rate of pCR in patients treated with surgery followed 7 or 8 weeks later (RR, 1.45; 95% CI, 1.18-1.78; and P < 0.01 and RR, 1.49; 95% CI, 1.15-1.92; and P = 0.002, resp.). There is no consistent evidence of improved local control or overall survival with longer or shorter intervals. Conclusion. Performing surgery 7-8 weeks after the end of NCRT results in the highest chance of achieving pCR. For candidates of abdominoperineal resection before NCRT, these data support implementation of prolonging the interval after NCRT to optimize the chances of pCR and perhaps add to the possibility of ultimate organ preservation.

No MeSH data available.


Related in: MedlinePlus