Fluorouracil-based neoadjuvant chemoradiotherapy with or without oxaliplatin for treatment of locally advanced rectal cancer: An updated systematic review and meta-analysis.
To measure the safety and efficacy of oxaliplatin (OX) application in neoadjuvant chemoradiotherapy (CRT) for locally advanced rectal cancer (LARC), EMBASE, PubMed, Cochrane Library, and Web of Science were used for a literature search. Cochrane's risk of bias tool of randomized controlled trials (RCTs) was used for quality evaluation. The statistical analyses were performed using RevMan 5.3. In addition, 95% confidence intervals (CIs) and pooled risk ratios (RRs) were calculated. Seven RCTs were included in our meta-analysis. After adding OX to fluoropyrimidine (FU), a marginal significant improvement in disease-free survival was noted compared with FU alone (RR = 0.89, 95% CI: 0.78-1.00; P = 0.05). Neoadjuvant CRT with OX significantly decreased the distant metastasis rate (RR = 0.79, 95% CI: 0.67-0.94, P = 0.007). However, no improvement in the local recurrence rate (RR = 0.86, 95% CI: 0.68-1.08; P = 0.19) was noted. In addition, neoadjuvant CRT with OX also significantly increased the pathologic complete response (RR = 1.24, 95% CI: 1.02-1.51; P = 0.03). Grade 3-4 acute toxicity and grade 3-4 diarrhea was considerably higher for OX/FU compared with FU alone. In conclusion, the use of OX on the basis of FU/capecitabine in preoperative CRT is feasible. LARC patients are likely to benefit from CRT regimens with OX.
Department of Radiation Oncology, Cancer Hospital of Jilin Province, Changchun, 130012, People's Republic of China.
Yong-Jing
YJ
Yang
Department of Radiation Oncology, Cancer Hospital of Jilin Province, Changchun, 130012, People's Republic of China.
Ling
L
Cao
Department of Anesthesiology, The First Hospital Affiliated to Jilin University, Changchun, 130012, People's Republic of China.
Zhi-Wen
ZW
Li
Department of Radiation Oncology, Cancer Hospital of Jilin Province, Changchun, 130012, People's Republic of China.
Ling
L
Zhao
Department of Radiation Oncology, Cancer Hospital of Jilin Province, Changchun, 130012, People's Republic of China.
Hong-Fen
HF
Wu
Department of Radiation Oncology, Cancer Hospital of Jilin Province, Changchun, 130012, People's Republic of China.
Dan
D
Yue
Department of Radiation Oncology, Cancer Hospital of Jilin Province, Changchun, 130012, People's Republic of China.
Jin-Lei
JL
Yang
Department of Radiation Oncology, Fudan University Shanghai Cancer Center, Shanghai, 200032, People's Republic of China.
Zhi-Rui
ZR
Zhou
Department of Radiation Oncology, Cancer Hospital of Jilin Province, Changchun, 130012, People's Republic of China.
Shi-Xin
SX
Liu
D000971:Antineoplastic Combined Chemotherapy Protocols / Q000008:administration & dosage; D059186:Chemoradiotherapy, Adjuvant / Q000379:methods*; 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* / Q000532:radiotherapy
D009944:Organoplatinum Compounds; D000077150:Oxaliplatin; D005472:Fluorouracil
meta-analysis; neoadjuvant chemoradiotherapy; oxaliplatin; rectal neoplasms