Systematic review of outcomes after total neoadjuvant therapy for locally advanced rectal cancer. BJS 2019; 106: 979-987.
Published: 10th May 2019
Authors: A. Zaborowski, A. Stakelum, D. C. Winter
Advances in surgical technique and the development of combined‐modality therapy have led to significantly improved local control in rectal cancer. Distant failure rates however, remain high, ranging between 20 and 30 per cent. Additional systemic chemotherapy in the preoperative period has been proposed as a means of eradicating subclinical micrometastases and improving long‐term survival. The purpose of this systematic review was to evaluate the current evidence regarding induction chemotherapy in combination with standard neoadjuvant chemoradiotherapy, in terms of oncological outcomes, in patients with rectal cancer.
A systematic review of the literature was performed to evaluate oncological outcomes and survival in patients with rectal cancer who underwent induction chemotherapy and neoadjuvant chemoradiotherapy, followed by surgical resection. Four major databases (PubMed, Embase, Scopus and Cochrane) were searched. The review included all original articles published in English reporting long‐term outcomes, specifically survival data, and was limited to prospective studies only.
A total of 686 studies were identified. After applying inclusion and exclusion criteria, ten studies involving 648 patients were included. Median follow‐up was 53·7 (range 26–80) months. Five‐year overall and disease‐free survival rates were 74·4 and 65·4 per cent respectively. Weighted mean local recurrence and distant failure rates were 3·5 (range 0–7) and 20·6 (range 5–31) per cent respectively.
Total neoadjuvant therapy should be considered in patients with high‐risk locally advanced rectal cancer owing to improved chemotherapy compliance and disease control. Further prospective studies are required to determine whether this approach translates into improved disease‐related survival or increases the proportion of patients suitable for non‐operative management.Full text
You may also be interested in
Early MRI predictors of disease‐free survival in locally advanced rectal cancer from the GRECCAR 4 trial.
Authors: S. Nougaret, F. Castan, H. de Forges, H. A. Vargas, B. Gallix, S. Gourgou et al.
Secondary technical resectability of colorectal cancer liver metastases after chemotherapy with or without selective internal radiotherapy in the randomized SIRFLOX trial.
Authors: B. Garlipp, P. Gibbs, G. A. Van Hazel, R. Jeyarajah, R. C. G. Martin, C. J. Bruns et al.
Population‐based study of the impact of small bowel obstruction due to adhesions on short‐ and medium‐term mortality.
Authors: R. Behman, A. B. Nathens, B. Haas, N. Look Hong, P. Pechlivanoglou, P. Karanicolas et al.
Authors: M. E. Stellingwerf, S. Sahami, D. C. Winter, S. T. Martin, G. R. D'Haens, G. Cullen et al.
Long‐term follow‐up of the AVOD randomized trial of antibiotic avoidance in uncomplicated diverticulitis.
Authors: D. Isacson, K. Smedh, M. Nikberg, A. Chabok
Pushing the boundaries of pelvic exenteration by maintaining survival at the cost of morbidity. BJS 2019; 106: 1393-1403.
Authors: R. L. Venchiarutti, M. J. Solomon, C. E. Koh, J. M. Young, D. Steffens
Meta‐analysis of the role of colonoscopy after an episode of left‐sided acute diverticulitis. BJS 2019; 106: 988-997.
Authors: S. J. Rottier, S. T. Dijk, A. A. W. Geloven, W. H. Schreurs, W. A. Draaisma, W. A. Enst et al.
Randomized clinical trial
Multicentre randomized clinical trial of colonic J pouch or straight stapled colorectal reconstruction after low anterior resection for rectal cancer.
Authors: S. Pucciarelli, P. Del Bianco, U. Pace, F. Bianco, A. Restivo, I. Maretto et al.
Authors: T. O. Sillo, A. D. Beggs, D. G. Morton, G. Middleton
Meta‐analysis of the effect of extending the interval after long‐course chemoradiotherapy before surgery in locally advanced rectal cancer. BJS 2019; 106: 1298-1310.
Authors: É. J. Ryan, D. P. O'Sullivan, M. E. Kelly, A. Z. Syed, P. C. Neary, P. R. O'Connell et al.
Randomized clinical trial
Randomized clinical trial of accelerated enhanced recovery after minimally invasive colorectal cancer surgery (RecoverMI trial). BJS 2019; 106: 1311-1318.
Authors: B. K. Bednarski, T. P. Nickerson, Y. N. You, C. A. Messick, B. Speer, V. Gottumukkala et al.
Organoids from colorectal peritoneal metastases as a platform for improving hyperthermic intraperitoneal chemotherapy. BJS 2019; 106: 1404-1414.
Authors: I. Ubink, A. C. F. Bolhaqueiro, S. G. Elias, D. A. E. Raats, A. Constantinides, N. A. Peters et al.