Abstract：
Neoadjuvant short course radiotherapy (SCRT) followed by consolidation chemotherapy (CCT) is an alternative treatment for locally advanced rectal cancer (LARC). We performed this systematic review and meta-analysis to explore the tumor response and oncological outcomes of this new approach compared to conventional chemoradiotherapy (CRT). An online search of the PubMed, Embase, and Cochrane Library databases was performed. This review included 7507 patients from 14 different cohorts. The pCR rate was higher with SCRT + CCT than that with CRT (RR: 1.60; 95% CI: 1.35−1.91; p < 0.01). SCRT + CCT provided a higher ypN0 response (RR: 1.06; 95% CI: 1.01−1.12; p = 0.02). There were no differences in R0 resection and positive CRM rates; however, more sphincter-preservation surgeries were performed in the SCRT + CCT arm (RR: 1.06; 95% CI: 1.01−1.11; p = 0.02). There was no difference in the OS and DFS between the SCRT + CCT and the CRT arms (OS: HR: 0.85, p = 0.07; DFS: HR: 0.88, p = 0.08). The compliance and toxicity were comparable between the SCRT and CRT groups. In the subgroup analysis, patients who underwent four or more cycles of CCT had better pCR and DFS events. Therefore, SCRT followed by consolidation chemotherapy might be an effective alternative treatment for LARC.
摘要：
新辅助短程放疗（SCRT）后再进行巩固化疗（CCT）是局部晚期直肠癌（LARC）的替代治疗方法。我们进行了系统评价和荟萃分析，以探讨与常规放化疗（CRT）相比，这种新方法的肿瘤反应和肿瘤结局。网上搜索PubMed,Embase,和Cochrane图书馆数据库进行。该综述包括来自14个不同队列的7507名患者。SCRT+CCT的pCR率高于CRT(RR:1.60;95%CI:1.35-1.91;p<0.01)。SCRT+CCT提供了更高的ypN0响应(RR:1.06;95%CI:1.01-1.12;p=0.02)。R0切除率和CRM阳性率没有差异；然而，SCRT+CCT组进行了更多的括约肌保存手术(RR:1.06;95%CI:1.01-1.11;p=0.02).SCRT+CCT和CRT臂之间的OS和DFS没有差异(OS:HR:0.85,p=0.07;DFS:HR:0.88,p=0.08)。SCRT组和CRT组的依从性和毒性相当。在亚组分析中，接受4个周期或4个周期以上CCT的患者的pCR和DFS事件较好.因此,SCRT随后进行巩固化疗可能是LARC的有效替代疗法。
