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ORIGINAL RESEARCH article

Front. Oncol.
Sec. Radiation Oncology
Volume 14 - 2024 | doi: 10.3389/fonc.2024.1515756
This article is part of the Research Topic Radiation Therapy and Organ Preservation: Controversies and Emerging Evidence View all 7 articles

Total neoadjuvant therapy based on short-course radiotherapy versus standard long-course chemoradiotherapy for locally advanced rectal cancer: A systematic review and meta-analysis of randomized controlled trials

Provisionally accepted
Wenji Pu Wenji Pu 1Zhi-yuan Xu Zhi-yuan Xu 1*Jing Jin Jing Jin 2*Haiman Jing Haiman Jing 1JISHI LI JISHI LI 1Jiang Yong Jiang Yong 1Shasha Li Shasha Li 1Weijie Wen Weijie Wen 1Wenqi Chen Wenqi Chen 1
  • 1 Shenzhen Hospital, The University of Hong Kong, Shenzhen, China
  • 2 National Cancer Center, Cancer Hospital Shenzhen Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Shenzhen, China

The final, formatted version of the article will be published soon.

    Background: We conducted the meta-analysis to compare the therapeutic effects of total neoadjuvant therapy (TNT) based on short-course radiotherapy followed by consolidation chemotherapy (SCRT/CCT) and long-course chemoradiotherapy (LCCRT) for locally advanced rectal cancer (LARC) according to certain significant randomized controlled trials (RCTs).Methods: The researchers retrieved several databases, including PubMed, Embase, Web of Science, and the Cochrane Library, to collect all the relevant literature published since the establishment of the databases until July 30, 2024, and then screened to determine the qualified literature and extracted the relevant information.Finally, RevMan 5.4 software was used to conduct the meta-analysis. There were 9 study indicators, including pCR rate, tumor downstaging rate, R0 resection rate, 2 sphincter preservation rate, disease-free survival (DFS), overall survival (OS), acute ≥3 grade toxicity rate, surgery complication rate, and distant recurrence rate. When moderate heterogeneity was found, a random-effect model was applied.Results: A total of 6 eligible RCTs and 2259 participants were included in this meta-analysis. Compared with the standard LCCRT, TNT treatment on the basis of SCRT/CCT increased pCR rate significantly [RR = 1.67, 95% CI (1.36, 2.04), P < 0.00001], especially in ≥ 4 cycles of the CCT arm [RR = 1.77, 95% CI: (1.41-2.23), p < 0.00001], and led to a similar tumor downstaging rate [RR = 0.99, 95% CI (0.85, 1.15), P = 0.92]. Moreover, survival outcomes, distant recurrence rate, and surgical indicators were comparable between the two groups.Conclusion: for LARC patients, the SCRT/CCT regimen not only has a higher pCR rate, equivalent OS, and comparable additional indicators versus standard LCCRT but also shortens the treatment time, costs less, and improves patients' adherence to the innovative anti-tumor therapy; hence, with the concept of acute toxicity control, it could be further widely and safely utilized, especially in resource-limited settings.

    Keywords: Locally advanced rectal cancer, short-course radiotherapy, Consolidation Chemotherapy, Total neoadjuvant therapy, Neoadjuvant chemoradiotherapy, Pathological complete response, overall survival, Disease free survival

    Received: 23 Oct 2024; Accepted: 02 Dec 2024.

    Copyright: © 2024 Pu, Xu, Jin, Jing, LI, Yong, Li, Wen and Chen. This is an open-access article distributed under the terms of the Creative Commons Attribution License (CC BY). The use, distribution or reproduction in other forums is permitted, provided the original author(s) or licensor are credited and that the original publication in this journal is cited, in accordance with accepted academic practice. No use, distribution or reproduction is permitted which does not comply with these terms.

    * Correspondence:
    Zhi-yuan Xu, Shenzhen Hospital, The University of Hong Kong, Shenzhen, China
    Jing Jin, National Cancer Center, Cancer Hospital Shenzhen Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Shenzhen, China

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