Hyun Jung Kim1,2, Jin Ho Song3,4, Hyeong Sik Ahn1,2, Bong-Hoi Choi5, Hojin Jeong3,4, Hoon Sik Choi3, Yun Hee Lee3,4, Ki Mun Kang3,4, Bae Kwon Jeong6,7. 1. Department of Preventive Medicine, College of Medicine, Korea University, Seoul, Republic of Korea. 2. Institute of Evidence-based Medicine, Korea University, Seoul, Republic of Korea. 3. Department of Radiation Oncology, Gyeongsang National University School of Medicine and Gyeongsang National University Hospital, Jinju, Republic of Korea. 4. Institute of Health Science, Gyeongsang National University, Jinju, Republic of Korea. 5. Department of Nuclear Medicine and Molecular Imaging, Gyeongsang National University Hospital, Jinju, Republic of Korea. 6. Department of Radiation Oncology, Gyeongsang National University School of Medicine and Gyeongsang National University Hospital, Jinju, Republic of Korea. blue129j@gnu.ac.kr. 7. Institute of Health Science, Gyeongsang National University, Jinju, Republic of Korea. blue129j@gnu.ac.kr.
Abstract
PURPOSE: Rectal cancer patients with a pathological complete response (pCR) after neoadjuvant concurrent chemoradiotherapy (CCRT) have a better prognosis compared to those without a pCR. Therefore, the "Wait and See" (W&S) approach in those who achieved clinically complete response (cCR) after CCRT was introduced as an alternative modality to the total mesorectal excision (TME). The aim of this study was to compare the oncological outcomes between W&S and TME via meta-analysis. METHODS: We performed a comprehensive literature search on January 14, 2016, using MEDLINE, EMBASE, the Cochrane Central Register of Controlled Trials, Web of Science, and Scopus. In addition, the references of all articles obtained were searched manually. The qualities of each study were assessed using the Newcastle-Ottawa quality assessment scale. The main outcomes were recurrence, disease-free survival (DFS), and overall survival (OS). We calculated the risk ratio (RR) and hazard ratio (HR) for the recurrence and survival rates, respectively. RESULTS: The RR of patients whose initial recurrences was local recurrence (LR), distant metastasis (DM), LR + DM, or overall recurrences were 0.18, 1.00, 0.61, and 0.49, respectively. There was no heterogeneity in the results. The HR of DFS was 0.59 and indicated that DFS in the TME group was superior compared with that in the W&S group. The OS has no significant difference between the studies. CONCLUSIONS: Although the W&S approach seemed feasible for rectal cancer patients with a cCR after neoadjuvant CCRT, concrete evidence obtained in well-controlled randomized trials with a long-term follow-up is required to validate potential treatment options.
PURPOSE:Rectal cancerpatients with a pathological complete response (pCR) after neoadjuvant concurrent chemoradiotherapy (CCRT) have a better prognosis compared to those without a pCR. Therefore, the "Wait and See" (W&S) approach in those who achieved clinically complete response (cCR) after CCRT was introduced as an alternative modality to the total mesorectal excision (TME). The aim of this study was to compare the oncological outcomes between W&S and TME via meta-analysis. METHODS: We performed a comprehensive literature search on January 14, 2016, using MEDLINE, EMBASE, the Cochrane Central Register of Controlled Trials, Web of Science, and Scopus. In addition, the references of all articles obtained were searched manually. The qualities of each study were assessed using the Newcastle-Ottawa quality assessment scale. The main outcomes were recurrence, disease-free survival (DFS), and overall survival (OS). We calculated the risk ratio (RR) and hazard ratio (HR) for the recurrence and survival rates, respectively. RESULTS: The RR of patients whose initial recurrences was local recurrence (LR), distant metastasis (DM), LR + DM, or overall recurrences were 0.18, 1.00, 0.61, and 0.49, respectively. There was no heterogeneity in the results. The HR of DFS was 0.59 and indicated that DFS in the TME group was superior compared with that in the W&S group. The OS has no significant difference between the studies. CONCLUSIONS: Although the W&S approach seemed feasible for rectal cancerpatients with a cCR after neoadjuvant CCRT, concrete evidence obtained in well-controlled randomized trials with a long-term follow-up is required to validate potential treatment options.
Entities:
Keywords:
Chemoradiotherapy; Mesorectal excision; Overall survival; Rectal cancer; Salvage therapy; Wait and see
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