ArticleTranslational cancer research2020
Comparison of different chemoradiotherapy regimens for the preoperative treatment in patients with locally advanced rectal cancer: a network meta-analysis.
Article in Translational cancer research, 2020. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.
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6 authors at 2 institutions in 1 country.
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Abstract
backgroundThe efficacy of different neoadjuvant chemoradiotherapy regimens on locally advanced rectal cancer (LARC) remains confusing. We evaluated them together via a network meta-analysis in terms of survival benefits to find the optimal treatment.
methodsWe searched, EMBASE, Cochrane Central Register of Controlled Trials and the ClinicalTrials website according to the selection criteria for eligible publications before Oct 25, 2019. Pathological complete response rate (pCR), disease-free survival (DFS), and overall survival (OS) were analyzed based on Bayesian methods in the meta-analysis.
resultsTwenty-five articles containing 7,142 participants and 12 preoperative regimens were analyzed. In terms of pCR, radiation therapy plus 5-fluorouracil (RT+5-Fu), RT plus capecitabine (RT+CAPE), RT plus 5-fluorouracil and oxaliplatin (RT+FOLFOX), RT plus capecitabine and oxaliplatin (RT+XELOX), and RT plus S-1 and irinotecan (RT+IS) were better than RT alone [odds ratio (OR) =2.66, 95% credible interval [CrI], 1.38-5.01; OR =3.11, 95% CrI: 1.33-6.98; OR =4.03, 95% CrI: 1.77-9.47; OR =4.22, 95% CrI: 1.60-10.87; OR =4.55, 95% CrI: 1.11-18.88, respectively] and RT+FOLFOX and RT+XELOX were superior to FOLFOX (OR =4.58, 95% CrI: 1.57-14.19; OR =4.81, 95% CrI: 1.20-18.73), too. Benefits could be seen on comparing RT+CAPE, RT+FOLFOX, and RT+XELOX with RT (OR =0.84, 95% CrI: 0.73-0.97; OR =0.88, 95% CrI: 0.80-0.97; OR =0.79, 95% CrI: 0.66-0.95, respectively) in DFS. RT+XELOX seemed to have better effects on OS compared than RT+5-Fu and RT+CAPE (OR =0.78, 95% CrI: 0.61-1.00; OR =0.86, 95% CrI: 0.74-1.00, respectively). Moreover, according to surface under the cumulative ranking curve analysis, RT+XELOX had the best outcomes in terms of pCR (79.18%) and OS (83.49%) and RT plus capecitabine, irinotecan, and cetuximab (RT+XELIRI+CET) ranked first with respect to DFS (87.86%).
conclusionsRT+XELOX is likely to be the best treatment with a comprehensive curative effect and the standard treatment of 5-fluorouracil-based chemoradiotherapy has some advantages, as well. More relevant evidence is needed for clinicians' guidance.
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