Copyright ©The Author(s) 2021. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Gastrointest Oncol. Sep 15, 2021; 13(9): 1196-1209
Published online Sep 15, 2021. doi: 10.4251/wjgo.v13.i9.1196
Neoadjuvant chemotherapy without radiation as a potential alternative treatment for locally advanced rectal cancer: A meta-analysis
Pei Wu, Hui-Mian Xu, Zhi Zhu
Pei Wu, Department of Gastrointestinal Surgery, Yongchuan Hospital of Chongqing Medical University, Chongqing 402160, China
Pei Wu, Hui-Mian Xu, Zhi Zhu, Department of Surgical Oncology, The First Hospital of China Medical University, Shenyang 110001, Liaoning Province, China
Author contributions: Wu P and Zhu Z contributed to study concept and design, acquisition of data, analysis and interpretation of data, and drafting of the manuscript; Wu P, Zhu Z, and Xu HM performed statistical analysis.
Supported by National Natural Science Foundation of China, No. 81302129.
Conflict-of-interest statement: The authors have no competing interests to declare.
PRISMA 2009 Checklist statement: The authors have read the PRISMA 2009 Checklist, and the manuscript was prepared and revised according to the PRISMA 2009 Checklist.
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See:
Corresponding author: Zhi Zhu, PhD, Doctor, Department of Surgical Oncology, The First Hospital of China Medical University, No. 155 Nanjing Street, Shenyang 110001, Liaoning Province, China.
Received: February 6, 2021
Peer-review started: February 6, 2021
First decision: May 8, 2021
Revised: June 1, 2021
Accepted: July 19, 2021
Article in press: July 19, 2021
Published online: September 15, 2021
Research background

Neoadjuvant chemoradiotherapy (Neo-CRT) is the current standard strategy for treatment of locally advanced rectal cancer (LARC). However, it delays the administration of optimal chemotherapy and increases toxicity.

Research motivation

This meta-analysis aimed to compare the feasibility and efficacy of neoadjuvant chemotherapy (Neo-CT) vs Neo-CRT for treatment of LARC.

Research objectives

To the best of our knowledge, this is the first meta-analysis to compare the efficacy and safety of Neo-CT without radiation vs Neo-CRT for rectal cancer patients, which included 19 randomized control trials or cohort studies published up to September 30, 2020.

Research methods

The hazard ratio of overall survival and the risk ratio for the pathological complete response, the sphincter preservation rate, and treatment-related adverse events were analyzed.

Research results

The results of this study showed that Neo-CT decreased the incidences of anastomotic fistula and temporary colostomy and increased the sphincter preservation rate. Meanwhile, there was no significant difference in overall survival, the tumor downstaging rate, overall complications, urinary complications, and pathological complete response rates.

Research conclusions

Neo-CT was effective for treatment of LARC, especially to lower the incidences of anastomotic fistula and temporary colostomy and increase the sphincter preservation rate as compared to Neo-CRT and could have the potential to provide an alternative to CRT for LARC.

Research perspectives

All in all, owing to the negligible heterogeneity of every endpoint and the inclusion of only high-quality studies, these preliminary results suggested that the combination of full-dose Neo-CT without radiation presented a new neoadjuvant treatment option for LARC.