Should Short-course Neoadjuvant Radiotherapy Be Applied for Low-lying Rectal Cancer? A Systematic Review and Meta-analysis of the Randomized Trials
Abstract
BACKGROUND
National Comprehensive Cancer Network guidelines recommend either long-course chemoradiation (LC) or short-course radiation (SC, 5 × 5 Gy) for rectal cancer before total mesorectal excision. However, they do not recommend SC for low-lying tumors. As early toxicity of SC is lower than that of LC, and postoperative complications as well as late toxicity are similar, the probable reason is a notion that for low-lying tumors LC may be more effective than SC in assuring local control.
MATERIAL AND METHODS
A systematic review and meta-analysis of the randomized trials comparing SC with LC was performed to test the hypothesis that for low-lying tumors, LC is superior to SC in reducing the risk of local failure.
RESULTS
The systematic search identified four trials including in total 421 patients with tumors <5 cm from the anal verge; 221 were randomized to SC and 200 to LC. The meta-analysis showed that the difference in local failure rate between SC and LC was insignificant; the pooled odds ratio was 0.87, 95% confidence interval 0.53-1.44, P = .59. Heterogeneity between trials was insignificant; I2 = 0.0%, P = .47.
CONCLUSION
Our meta-analysis does not support the notion that LC given prior to total mesorectal excision is superior to SC in reducing the risk of local failure in low-lying tumors.
How strong is the evidence?
Evidence Hub reads this as a meta-analysis, done in people. Its evidence level is 1 of 5 (Highest · pooled evidence). Pooled evidence from several studies sits at the top of the evidence pyramid. Reported size: 421 participants or records.
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