title: Adjuvant Chemotherapy in Rectal Cancer after Chemoradiotherapy.
abstract: The aim of this overview was to investigate whether adjuvant chemotherapy has a favourable effect on the outcome of patients with rectal cancer who had preoperative (chemo)radiotherapy. A review of randomised clinical trials that allocated patients between fluorouracil-based and observation or between fluorouracil-based and oxaliplatin-based adjuvant chemotherapy after preoperative (chemo)radiotherapy was carried out, including their corresponding meta-analyses. None of the five randomised trials has shown a significant benefit of fluorouracil-based adjuvant chemotherapy for overall survival or disease-free survival. Also, the three corresponding meta-analyses failed to show a benefit of adjuvant treatment. Of three randomised trials - two phase III and one phase II with a 3-year disease-free survival end point - two showed a small benefit of adding oxaliplatin to fluorouracil, one failed. The corresponding meta-analyses showed that the pooled difference was not significant. In conclusion, the use of postoperative 5-fluorouracil-based chemotherapy with or without oxaliplatin in patients with rectal cancer after preoperative (chemo)radiotherapy is not scientifically proven.
authors.affiliation: Department of Radiation Oncology, University Hospital of Besançon, Besançon, France.
authors.forename: J
authors.initials: J
authors.lastname: Boustani
authors.affiliation: Department of Radiation Oncology, University Hospital of Besançon, Besançon, France.
authors.forename: M
authors.initials: M
authors.lastname: Caubet
authors.affiliation: Department of Radiation Oncology, University Hospital of Besançon, Besançon, France; University of Franche-Comté, Besançon, France. Electronic address: jean-francois.bosset@univ-fcomte.fr.
authors.forename: J-F
authors.initials: JF
authors.lastname: Bosset
mesh_terms: D000971:Antineoplastic Combined Chemotherapy Protocols / Q000627:therapeutic use*; D059186:Chemoradiotherapy, Adjuvant / Q000379:methods*; D018572:Disease-Free Survival; D005472:Fluorouracil / Q000008:administration & dosage; D006801:Humans; D020360:Neoadjuvant Therapy / Q000379:methods*; D009944:Organoplatinum Compounds / Q000008:administration & dosage; D000077150:Oxaliplatin; D012004:Rectal Neoplasms / Q000188:drug therapy* / Q000401:mortality / Q000532:radiotherapy
chemical_list: D009944:Organoplatinum Compounds; D000077150:Oxaliplatin; D005472:Fluorouracil
keywords: Adjuvant chemotherapy; meta-analysis; preoperative chemoradiotherapy; preoperative radiotherapy; rectal cancer