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Evidence summaries

Preoperative Chemoradiation Versus Radiation Alone for Stage II and III Resectable Rectal Cancer

Compared to preoperative radiotherapy alone, preoperative chemoradiation (CRT) may not increase overall survival or disease-free survival, although it enhances pathological response and improves local control in resectable stage II and III rectal cancer. The effects of preoperative CRT on functional outcome and quality of life are incompletely understood. Level of evidence: "C"

Summary

A Cochrane review [Abstract] 1 included 5 studies. The addition of chemotherapy to preoperative RT significantly increased grade III and IV acute toxicity (OR 1.68-10, P = 0.002) and marginally affected postoperative overall morbidity (OR 0.67-1.00, P = 0.05) while no differences were observed in postoperative mortality or anastomotic leak rate. Compared to preoperative RT alone, preoperative CRT significantly increased the rate of complete pathological response (OR 2.12-5.84, P < 0.00001) although this did not translate into a higher sphincter preservation rate (OR 0.92-1.30, P = 0.32). The incidence of local recurrence at five years was significantly lower in the CRT group compared to RT alone (OR 0.39-0.72, P < 0.001). No statistically significant differences were observed in DFS (OR 0.92-1.34, P = 0.27) or OS (OR 0.79-1.14, P = 0.58) at five years.

    References

    • De Caluwé L, Van Nieuwenhove Y, Ceelen WP. Preoperative chemoradiation versus radiation alone for stage II and III resectable rectal cancer. Cochrane Database Syst Rev 2013;(2):CD006041. [PubMed]

Primary/Secondary Keywords