Department of General Surgery, Endocrine and Transplant Surgery, Medical University of Gdansk, Gdańsk, Poland.
Department of Oncology and Hemato-Oncology, University of Milan, Milan, Italy.
Acta Oncol. 2021 Oct;60(10):1308-1316. doi: 10.1080/0284186X.2021.1953137. Epub 2021 Jul 24.
Short-course radiotherapy with consolidation chemotherapy (SCRT-CCT) has emerged as a promising alternative to the long course chemoradiotherapy (LCRT) regimen in locally advanced rectal cancer management. The systematic review and meta-analysis is aimed at summarizing current evidence on SCRT-CCT and comparing it to LCRT.
Electronic databases of MEDLINE, Web of Science, and Cochrane library were searched using a predefined search strategy returning 3314 articles. This review included 11 studies (6 randomized trials and 5 non-randomized studies) on SCRT-CCT regimen based on seven different cohorts. Weighted arithmetic means and forest plots were generated to determine summary estimates.
The probability of achieving pathological complete response (pCR) was higher with SCRT-CCT compared to LCRT (risk ratio [RR] = 1.75, 95% confidence interval [CI]: 1.41-2.19). No statistically significant difference in 3-year overall survival (OS) was observed between the two groups (RR= 1.06, 95% CI: 0.98-1.14). The weighted arithmetic mean of 3-year OS and pCR was 83.6% 80.9%, and 24.5% 13.6% for SCRT-CCT and LCRT, respectively. R0 resection and T-downstaging rates ranged from 69.2-100% to 47-75% for SCRT-CCT, and 71-92.3% and 41-75% for LCRT, respectively. The regimens had similar compliance, postoperative, and late toxicity, however, acute toxicity rates varied primarily due to differences in treatment protocols.
This review highlights the ability of SCRT-CCT to produce improved tumor response with comparable OS, R0 resection, and T-downstaging at the cost of increased acute toxicity. However, heterogeneity in treatment protocols across studies makes it difficult to provide definitive conclusions regarding the regimen. Several ongoing trials are expected to provide further evidence confirming the findings of RAPIDO trial and detail appropriate SCRT-CCT protocols to improve oncological outcomes, minimize toxicity, and determine its effectiveness as the standard-of-care for locally advanced rectal cancer patients.
短程放疗联合巩固化疗（SCRT-CCT）已成为局部晚期直肠癌管理中替代长程放化疗（LCRT）方案的一种有前途的方法。本系统评价和荟萃分析旨在总结 SCRT-CCT 的现有证据，并将其与 LCRT 进行比较。
通过预设的搜索策略，在 MEDLINE、Web of Science 和 Cochrane 图书馆的电子数据库中进行搜索，共检索到 3314 篇文章。本综述纳入了 11 项基于 7 个不同队列的 SCRT-CCT 方案研究（6 项随机试验和 5 项非随机研究）。使用加权算术平均值和森林图来确定汇总估计值。
与 LCRT 相比，SCRT-CCT 实现病理完全缓解（pCR）的概率更高（风险比 [RR] = 1.75，95%置信区间 [CI]：1.41-2.19）。两组 3 年总生存率（OS）无统计学差异（RR=1.06，95%CI：0.98-1.14）。SCRT-CCT 和 LCRT 的 3 年 OS 和 pCR 的加权算术平均值分别为 83.6%和 80.9%，24.5%和 13.6%。SCRT-CCT 的 R0 切除率和 T 降期率范围为 69.2-100%至 47-75%，LCRT 的 R0 切除率和 T 降期率范围为 71-92.3%和 41-75%。这两种方案的依从性、术后和晚期毒性相似，但由于治疗方案的差异，急性毒性发生率不同。
本综述强调了 SCRT-CCT 在提高肿瘤反应率方面的能力，同时具有可比性的 OS、R0 切除率和 T 降期率，但代价是增加了急性毒性。然而，由于研究之间治疗方案的异质性，很难对该方案得出明确的结论。几项正在进行的试验预计将提供进一步的证据，证实 RAPIDO 试验的结果，并详细说明适当的 SCRT-CCT 方案，以改善肿瘤学结果，最大程度地降低毒性，并确定其作为局部晚期直肠癌患者的标准治疗方法的有效性。
