Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
Review
. 2022 Aug 26:9:911538.
doi: 10.3389/fsurg.2022.911538. eCollection 2022.

Total neoadjuvant therapy or standard chemoradiotherapy for locally advanced rectal cancer: A systematic review and meta-analysis

Zhou Ma  1   2 , Ling Tan  3 , Zi-Lin Liu  1 , Jiang-Wei Xiao  1
Affiliations
Review

Total neoadjuvant therapy or standard chemoradiotherapy for locally advanced rectal cancer: A systematic review and meta-analysis

Zhou Ma et al. Front Surg. .

Abstract

Background and aim: The effectiveness of total neoadjuvant therapy (TNT) on patients with locally advanced rectal cancer (LARC) is controversy. This study aims to compare the prognostic value of TNT with standard neoadjuvant chemoradiotherapy (CRT) for LARC.

Methods: We searched databases (Embase [Ovid], Medline [Ovid], PubMed, Cochrane Library, and Web of Science) for articles published between January 1, 2000, and March 10, 2022. Studies on evaluating the effects of TNT and standard CRT on the prognosis of LARC were included. The primary outcomes were overall survival (OS) and disease-free survival (DFS).

Results: 19 primary studies, involving 10 randomized controlled trials, 3 prospective studies and 6 retrospective studies, with data on 5,074 patients treated for LARC were included in the meta-analysis. Statistical analyses revealed that, compared with standard CRT, TNT significantly improved OS (hazard ratio [HR]=0.77, 95% confidence interval [CI]=0.65-0.90, I 2 = 30%, P = 0.17), DFS (HR = 0.85, 95% CI = 0.74-0.97, I² = 11%, P = 0.35), distant metastases-free survival (DMFS, HR = 0.76, 95% CI = 0.65-0.90, I² = 0%, P = 0.50), pathological complete response rate (pCR, OR = 1.89, 95% CI = 1.61-2.22, I² = 0%, P = 0.47), and R0 resection rate (OR = 1.33, 95% CI = 1.07-1.67, I² = 16%, P = 0.28), but local recurrence-free survival (LRFS, HR = 1.12, 95% CI = 0.90-1.39, I² = 4%, P = 0.37).

Conclusions: Comprehensive literature research shows that TNT showed excellent short-term efficacy in terms of pCR and R0 resection rate while also improved the long-term outcomes of OS, DFS and DMFS, might become a new standard of treatment in patients with LARC. Even so, more studies and longer follow-up were still warranted.

Keywords: locally advanced rectal cancer; meta-analysis; prognosis; standard chemoradiotherapy; total neoadjuvant therapy.

PubMed Disclaimer

Conflict of interest statement

The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest.

Figures

Figure 1
Figure 1
PRISMA flowchart of search strategy and study selection.
Figure 2
Figure 2
Forest plots for the meta-analyses. (A): pCR; (B): R0 resection.
Figure 3
Figure 3
Forest plots for the meta-analyses. (A): OS; (B): DFS; (C): LRFS; (D): DMFS.
Figure 4
Figure 4
Funnel plot of publication bias in the meta-analysis. (A): pCR; (B): R0 resection; (C): OS; (D): DFS; (E): LRFS; (F): DMFS.
See this image and copyright information in PMC

Similar articles

See all similar articles

Cited by

See all "Cited by" articles

References

    1. Brody H. Colorectal cancer. Nature. (2015) 521(7551):S1. 10.1038/521S1a - DOI - PubMed
    1. Keller DS, Berho M, Perez RO, Wexner SD, Chand M. The multidisciplinary management of rectal cancer. Nat Rev Gastroenterol Hepatol. (2020) 17(7):414–29. 10.1038/s41575-020-0275-y - DOI - PubMed
    1. Erlandsson J, Holm T, Pettersson D, Berglund Å, Cedermark B, Radu C, et al. Optimal fractionation of preoperative radiotherapy and timing to surgery for rectal cancer (Stockholm III): a multicentre, randomised, non-blinded, phase 3, non-inferiority trial. Lancet Oncol. (2017) 18(3):336–46. 10.1016/S1470-2045(17)30086-4 - DOI - PubMed
    1. van Gijn W, Marijnen C, Nagtegaal I, Kranenbarg E, Putter H, Wiggers T, et al. Preoperative radiotherapy combined with total mesorectal excision for resectable rectal cancer: 12-year follow-up of the multicentre, randomised controlled TME trial. Lancet Oncol. (2011) 12(6):575–82. 10.1016/S1470-2045(11)70097-3 - DOI - PubMed
    1. Sebag-Montefiore D, Stephens RJ, Steele R, Monson J, Grieve R, Khanna S, et al. Preoperative radiotherapy versus selective postoperative chemoradiotherapy in patients with rectal cancer (MRC CR07 and NCIC-CTG C016): a multicentre, randomised trial. Lancet. (2009) 373(9666):811–20. 10.1016/S0140-6736(09)60484-0 - DOI - PMC - PubMed