Bécouarn Y, Guillo S, Artru P, Assenat E, Bosset J-F, Conroy T, François E, Taïeb J, Touboul E
oncologue médical, institut Bergonié, Bordeaux, France.
Bull Cancer. 2008 Jul-Aug;95(7):717-34.
At the request of the National Thesaurus of Gastrointestinal Cancer (TNCD), the SOR program undertaken by the French federation of cancer centers and now led by the French National Cancer Institute, completed a systematic review to evaluate the value of perioperative chemotherapy in the management of resectable rectal adenocarcinoma in collaboration with clinician experts.
Results of a systematic literature search using Medline and Embase (from January 1996 to October 2007) were completed by a survey of Evidence- Based Medicine websites. All phase III randomized trials and systematic reviews comparing surgery (alone or associated with adjuvant therapy) to the same treatment plus chemotherapy, or comparing different perioperative chemotherapy modalities in patients with resectable rectal adenocarcinoma, were included in the study. The quality and clinical relevance of the trials were evaluated using validated checklists, allowing to associate each result with its level of evidence. Data synthesis was performed taking into account both efficacy and toxicity outcomes for each intervention. Finally, research recommendations were formulated.
Of 29 studies meeting the selection criteria, 19 were included after critical methodological and clinical appraisal. As compared with preoperative radiotherapy, preoperative chemoradiotherapy with 5-fluorouracil and folinic acid does not improve overall or relapse-free survivals but decreases local recurrence rates. Postoperative chemotherapy with 5-fluorouracil and folinic acid does not improve overall or relapse-free survivals, whether the patients received preoperative radiotherapy or preoperative chemoradiotherapy, whereas it seems to decrease local recurrence rates after preoperative radiotherapy but not after preoperative chemoradiotherapy. As compared with postoperative chemoradiotherapy, preoperative chemoradiotherapy with continuous infusion of 5-fluorouracil does not improve overall or relapse-free survivals, but decreases local recurrence rates as well as acute and long-term toxicities. In the absence of preoperative radiotherapy, fluoropyrimidine-based postoperative chemotherapy improves both overall and relapse-free survivals and decreases local recurrence rates.
Preoperative chemoradiotherapy reduces the risk of local recurrence as compared with preoperative radiotherapy or postoperative chemoradiotherapy.
应《胃肠道癌国家词库》（TNCD）的要求，由法国癌症中心联合会开展、现由法国国家癌症研究所牵头的SOR项目，与临床专家合作完成了一项系统评价，以评估围手术期化疗在可切除直肠腺癌管理中的价值。
通过检索循证医学网站，补充了使用Medline和Embase（1996年1月至2007年10月）进行系统文献检索的结果。本研究纳入了所有比较手术（单独或联合辅助治疗）与相同治疗加化疗，或比较可切除直肠腺癌患者不同围手术期化疗方式的III期随机试验和系统评价。使用经过验证的清单评估试验的质量和临床相关性，从而将每个结果与其证据水平相关联。综合考虑每种干预措施的疗效和毒性结果进行数据合成。最后，制定了研究建议。
在符合选择标准的29项研究中，经过严格的方法学和临床评估后，纳入了19项。与术前放疗相比，使用5-氟尿嘧啶和亚叶酸的术前放化疗并不能提高总生存率或无复发生存率，但可降低局部复发率。无论患者接受术前放疗还是术前放化疗，使用5-氟尿嘧啶和亚叶酸的术后化疗均不能提高总生存率或无复发生存率，而它似乎可降低术前放疗后的局部复发率，但不能降低术前放化疗后的局部复发率。与术后放化疗相比，持续输注5-氟尿嘧啶的术前放化疗不能提高总生存率或无复发生存率，但可降低局部复发率以及急性和长期毒性。在没有术前放疗的情况下，基于氟嘧啶的术后化疗可提高总生存率和无复发生存率，并降低局部复发率。
与术前放疗或术后放化疗相比，术前放化疗可降低局部复发风险。
