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The role of chemotherapy in localized and locally advanced rectal cancer: A systematic revision.

Abstract Curative treatment of rectal cancer depends on an optimal surgical resection, with the addition of neoadjuvant radiotherapy (RT) with or without concomitant chemotherapy (ChT) in more advanced tumors. The role of adjuvant ChT is controversial and a more intensified neoadjuvant approach with the addition of ChT before or after RT, or even as single modality, is currently being explored in trials. A systematic review selecting randomised phase II and III trials on the role of ChT in localized rectal cancer was performed. Data show that neoadjuvant ChRT improves locoregional control in resected rectal cancer. Short-course RT (SCRT) could give similar outcomes to ChRT. The addition of oxaliplatin to neoadjuvant ChRT marginally increases the pathological complete remission rate without improving survival and increasing toxicity. A more intensified approach remains investigational as trials to date have not shown significant advantages. Adjuvant ChT trials after preoperative ChRT are contentious, although the addition of oxaliplatin in high risk patients may benefit outcomes. Despite a wide heterogeneity in the target population, different staging procedures and diverse treatment approaches among different trials, this systematic review confirms the role of ChT in combination with neoadjuvant long-course RT. Adjuvant ChT could be of value in selected patients with high-risk features, mainly if they do not respond to neoadjuvant RT. Further investigation is warranted on more intensified neoadjuvant regimens including ChT for MRI-defined high-risk patients.
PMID
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Authors

Mayor MeshTerms
Keywords

Adjuvant chemotherapy

Preoperative chemoradiation

Rectal cancer

Journal Title cancer treatment reviews
Publication Year Start




PMID- 29407455
OWN - NLM
STAT- MEDLINE
DCOM- 20180209
LR  - 20180209
IS  - 1532-1967 (Electronic)
IS  - 0305-7372 (Linking)
VI  - 63
DP  - 2018 Feb
TI  - The role of chemotherapy in localized and locally advanced rectal cancer: A
      systematic revision.
PG  - 156-171
LID - S0305-7372(18)30001-X [pii]
LID - 10.1016/j.ctrv.2018.01.001 [doi]
AB  - Curative treatment of rectal cancer depends on an optimal surgical resection,
      with the addition of neoadjuvant radiotherapy (RT) with or without concomitant
      chemotherapy (ChT) in more advanced tumors. The role of adjuvant ChT is
      controversial and a more intensified neoadjuvant approach with the addition of
      ChT before or after RT, or even as single modality, is currently being explored
      in trials. A systematic review selecting randomised phase II and III trials on
      the role of ChT in localized rectal cancer was performed. Data show that
      neoadjuvant ChRT improves locoregional control in resected rectal cancer.
      Short-course RT (SCRT) could give similar outcomes to ChRT. The addition of
      oxaliplatin to neoadjuvant ChRT marginally increases the pathological complete
      remission rate without improving survival and increasing toxicity. A more
      intensified approach remains investigational as trials to date have not shown
      significant advantages. Adjuvant ChT trials after preoperative ChRT are
      contentious, although the addition of oxaliplatin in high risk patients may
      benefit outcomes. Despite a wide heterogeneity in the target population,
      different staging procedures and diverse treatment approaches among different
      trials, this systematic review confirms the role of ChT in combination with
      neoadjuvant long-course RT. Adjuvant ChT could be of value in selected patients
      with high-risk features, mainly if they do not respond to neoadjuvant RT. Further
      investigation is warranted on more intensified neoadjuvant regimens including ChT
      for MRI-defined high-risk patients.
CI  - Copyright (c) 2018 Elsevier Ltd. All rights reserved.
FAU - Rosello, Susana
AU  - Rosello S
AD  - CIBERONC, Department of Medical Oncology, Biomedical Research Institute INCLIVA, 
      University of Valencia, Valencia, Spain.
FAU - Papaccio, Federica
AU  - Papaccio F
AD  - Oncologia Medica, Dipartimento di Internistica Clinica e Sperimentale "F.
      Magrassi", Universita degli Studi della Campania Luigi Vanvitelli, Napoli, Italy.
FAU - Roda, Desamparados
AU  - Roda D
AD  - CIBERONC, Department of Medical Oncology, Biomedical Research Institute INCLIVA, 
      University of Valencia, Valencia, Spain.
FAU - Tarazona, Noelia
AU  - Tarazona N
AD  - CIBERONC, Department of Medical Oncology, Biomedical Research Institute INCLIVA, 
      University of Valencia, Valencia, Spain.
FAU - Cervantes, Andres
AU  - Cervantes A
AD  - CIBERONC, Department of Medical Oncology, Biomedical Research Institute INCLIVA, 
      University of Valencia, Valencia, Spain. Electronic address:
      [email protected]
LA  - eng
PT  - Journal Article
PT  - Review
DEP - 20180111
PL  - Netherlands
TA  - Cancer Treat Rev
JT  - Cancer treatment reviews
JID - 7502030
RN  - 0 (Antineoplastic Agents)
SB  - IM
MH  - Antineoplastic Agents/*therapeutic use
MH  - Clinical Trials, Phase II as Topic
MH  - Clinical Trials, Phase III as Topic
MH  - Combined Modality Therapy/methods
MH  - Humans
MH  - Neoadjuvant Therapy/methods
MH  - Radiotherapy, Adjuvant/methods
MH  - Randomized Controlled Trials as Topic
MH  - Rectal Neoplasms/*drug therapy/radiotherapy
OTO - NOTNLM
OT  - Adjuvant chemotherapy
OT  - Preoperative chemoradiation
OT  - Rectal cancer
EDAT- 2018/02/07 06:00
MHDA- 2018/02/10 06:00
CRDT- 2018/02/07 06:00
PHST- 2017/12/08 00:00 [received]
PHST- 2018/01/07 00:00 [revised]
PHST- 2018/01/09 00:00 [accepted]
PHST- 2018/02/07 06:00 [entrez]
PHST- 2018/02/07 06:00 [pubmed]
PHST- 2018/02/10 06:00 [medline]
AID - S0305-7372(18)30001-X [pii]
AID - 10.1016/j.ctrv.2018.01.001 [doi]
PST - ppublish
SO  - Cancer Treat Rev. 2018 Feb;63:156-171. doi: 10.1016/j.ctrv.2018.01.001. Epub 2018
      Jan 11.