Efficacy and Safety of Hyperthermo-Chemo-Radiotherapy for Rectal Cancer: A Systematic Review_Chinese Journal of Evidence-Based Medicine

Authors：

 LIZheng ^1,2,3 ,  MIDeng-hai ^1,2,3 , YANGKe-hu ^1,2 , CAONong ¹ , TIANJin-hui ² , MABin ² , BAIZheng-gang ²

1. The First Clinical Medical College of Lanzhou University, Lanzhou 730000, China;
2. Evidence Based Medicine Center of Lanzhou University, Lanzhou 730000, China;
3. The Second People's Hospital of Gansu Province, Lanzhou 730000, China;

Corresponding?author：

MIDeng-hai, Email: mi.dh@163.com

Keywords：

Rectal cancer; Hyperthermia; Chemotherapy; Radiotherapy; Systematic review; Meta-Analysis; Randomized controlled trial

DOI：

10.7507/1672-2531.20150114

Video：

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Objective To systematically review the efficacy and safety of chemo-radiotherapy combined with hyperthermia (HCRT) for rectal cancer, and to provide evidence for clinical practice. Methods We searched the Cochrane Library (Issue 6, 2014), PubMed, EMbase, Web of Science, CBM, CNKI, VIP and WanFang Data databases from inception to July 2014. All relevant randomized controlled trials (RCTs) of HCRT for rectal cancer were collected. Two reviewers independently screened literature, extracted data, and assessed the risk of bias of included studies. Then meta-analysis was performed using RevMan 5.3 software. Results A total of 9 RCTs involving 663 patients were included. The results of meta-analysis showed that:Compared with the chemo-radiotherapy (CRT) group, the HCRT group were significant superior in complete response (OR=3.74, 95%CI 2.14 to 6.53), total effective rate (OR=4.23, 95%CI 2.69 to 6.66), 3-year survival rate (OR=4.48, 95%CI 1.81 to 11.06) and recurrence rate (OR=0.19, 95%CI 0.09 to 0.42). ②Compared with the radiotherapy (RT) group, the HCRT group was associated with significant improvement in complete response rate (OR=3.01, 95%CI 1.24 to 7.29). Conclusion Current evidence shows, HCRT is superior to CRT or RT in the treatment of rectal cancer. However, due to the limited quantity and quality of the included studies, more high quality studies are needed to verify the above conclusion.

Citation： LIZheng, MIDeng-hai, YANGKe-hu, CAONong, TIANJin-hui, MABin, BAIZheng-gang. Efficacy and Safety of Hyperthermo-Chemo-Radiotherapy for Rectal Cancer: A Systematic Review. Chinese Journal of Evidence-Based Medicine, 2015, 15(6): 687-692. doi: 10.7507/1672-2531.20150114 Copy

1.	Torre LA,Bray F,Siegel RL,et al.Global cancer statistics,2012.CA Cancer J Clin,2015,65(2):87-108.
2.	周總光,楊烈,李園,等.我國結直腸癌30年變遷與應對策略.中國實用外科雜志,2012,32(9):693-696.
3.	Wust P,Hildebrandt B,Sreenivasa G,et al.Hyperthermia in combined treatment of cancer.Lancet Oncol,2002,3(8):487-497.
4.	Hildebrandt B,Rau B,Loffel J,et al.Adjuvant chemotherapy with folinic acid and 5-fluorouracil in patients with locally advanced rectal cancer previously treated by preoperative radiochemotherapy and curative tumor resection.Int J Colorectal Dis,2006,21(6):582-589.
5.	Furuta K,Konishi F,Kanazawa K,et al.Synergistic effects of hyperthermia in preoperative radiochemotherapy for rectal carcinoma.Dis Colon Rectum,1997,40(11):1303-1312.
6.	Kang MK,Kim MS,Kim JH.Clinical outcomes of mild hyperthermia for locally advanced rectal cancer treated with preoperative radiochemotherapy.Int J Hyperthermia,2011,27(5):482-490.
7.	米登海,李征,楊克虎,等.熱放化三聯療法治療非小細胞肺癌的Meta分析.中國循證醫學雜志,2011,11(11):1262-1267.
8.	米登海,李征,楊克虎,等.熱化放三聯療法治療食管癌的Meta分析.實用腫瘤雜志,2013,28(1):28-35.
9.	Guyatt GH,Oxman AD,Kunz R,et al.GRADE guidelines:8.Rating the quality of evidence--indirectness.J Clin Epidemiol,2011,64(12):1303-1310.
10.	Higgins JPT,Green S.Cochrane Handbook for Systematic Reviews of Interventions Version 5.1.0[updated March 2011].The Cochrane Collaboration,2011.Available at:www.cochrane.org/training/cochrane-handbook.
11.	喻志沖,袁洪香,王賀芳.局部晚期直腸癌綜合治療療效分析.中國臨床醫學,2003,10(6):851,853.
12.	Kouloulias V,Plataniotis G,Kouvaris J,et al.Chemoradiotherapy combined with intracavitary hyperthermia for anal cancer:feasibility and long-term results from a phase II randomized trial.Am J Clin Oncol,2005,28(1):91-99.
13.	趙軍,王寶中,盛延興,等.放化療結合相控陣聚焦熱療治療直腸癌術后局部區域復發的臨床觀察.中華腫瘤防治雜志,2009,16(21):1691-1693.
14.	代素梅,盧玉娟,劉洪敏,等.三維適形放射治療同步化療聯合熱療對局部晚期及術后局部復發直腸癌近期療效的研究.現代預防醫學,2011,38(10):1996-1997,1999.
15.	沈雄虎,金永民,張松男,等.術前放療、化療聯合熱療治療直腸癌局部復發的臨床分析.現代預防醫學,2011,38(19):4023-4024.
16.	Schroeder C,Gani C,Lamprecht U,et al.Pathological complete response and sphincter-sparing surgery after neoadjuvant radiochemotherapy with regional hyperthermia for locally advanced rectal cancer compared with radiochemotherapy alone.Int J Hyperthermia,2012,28(8):707-714.
17.	胡金飛,王道榮.新輔助放化療聯合熱療治療進展期直腸癌的臨床效果和安全性.中國醫藥導報,2013,10(30):64-66,70.
18.	溫本,鄭文滔,顏勁,等.新輔助放化療熱療聯合腹腔鏡手術治療進展期直腸癌的臨床療效.中國腫瘤臨床與康復,2013,20(11):1270-1272.
19.	鄧微.進展期直腸癌新輔助放化療加熱療的療效分析.中國保健營養(中旬刊),2014,4(24):2549.
20.	詹宏杰,梁寒.腫瘤熱療的研究.國外醫學(腫瘤學分冊),2005,32(1):35-38.
21.	Falk MH,Issels RD.Hyperthermia in oncology.Int J Hyperthermia,2001,17(1):1-18.
22.	vander Zee J.Heating the patient:a promising approach? Ann Oncol,2002,13(8):1173-1184.
23.	de Haas-Kock DF,Buijsen J,Pijls-Johannesma M,et al.Concomitant hyperthermia and radiation therapy for treating locally advanced rectal cancer.Cochrane Database Syst Rev,2009,(3):CD006269.
24.	頡寶平,李征,姚南,等.化療聯合熱療治療晚期大腸癌療效及安全性的Meta分析.中國循證醫學雜志,2013,13(3):352-357.
25.	張娜,朱遠.腫瘤熱放療、化療在直腸癌治療中的研究進展.實用腫瘤雜志,2008,23(6):586-590.
26.	Rau B,Wust P,Tilly W,et al.Preoperative radiochemotherapy in locally advanced or recurrent rectal cancer:regional radiofrequency hyperthermia correlates with clinical parameters.Int J Radiat Oncol Biol Phys,2000,48(2):381-391.
27.	Ichikawa D,Yamaguchi T,Yoshioka Y,et al.Prognostic evaluation of preoperative combined treatment for advanced cancer in the lower rectum with radiation,intraluminal hyperthermia,and 5-fluorouracil suppository.Am J Surg,1996,171(3):346-350.
28.	Wust P,Rau B,Gellerman J,et al.Radiochemotherapy and hyperthermia in the treatment of rectal cancer.Recent Results Cancer Res,1998,146:175-191.
29.	Asao T,Sakurai H,Harashima K,et al.The synchronization of chemotherapy to circadian rhythms and irradiation in pre-operative chemoradiation therapy with hyperthermia for local advanced rectal cancer.Int J Hyperthermia,2006,22(5):399-406.
30.	Milani V,Pazos M,Issels RD,et al.Radiochemotherapy in combination with regional hyperthermia in preirradiated patients with recurrent rectal cancer.Strahlenther Onkol,2008,184(3):163-168.
31.	Schulze T,Wust P,Gellermann J,et al.Influence of neoadjuvant radiochemotherapy combined with hyperthermia on the quality of life in rectum cancer patients.Int J Hyperthermia,2006,22(4):301-318.
32.	Bruggmoser G,Bauchowitz S,Canters R,et al.Quality assurance for clinical studies in regional deep hyperthermia.Strahlenther Onkol,2011,187(10):605-610.

1. Torre LA,Bray F,Siegel RL,et al.Global cancer statistics,2012.CA Cancer J Clin,2015,65(2):87-108.
2. 周總光,楊烈,李園,等.我國結直腸癌30年變遷與應對策略.中國實用外科雜志,2012,32(9):693-696.
3. Wust P,Hildebrandt B,Sreenivasa G,et al.Hyperthermia in combined treatment of cancer.Lancet Oncol,2002,3(8):487-497.
4. Hildebrandt B,Rau B,Loffel J,et al.Adjuvant chemotherapy with folinic acid and 5-fluorouracil in patients with locally advanced rectal cancer previously treated by preoperative radiochemotherapy and curative tumor resection.Int J Colorectal Dis,2006,21(6):582-589.
5. Furuta K,Konishi F,Kanazawa K,et al.Synergistic effects of hyperthermia in preoperative radiochemotherapy for rectal carcinoma.Dis Colon Rectum,1997,40(11):1303-1312.
6. Kang MK,Kim MS,Kim JH.Clinical outcomes of mild hyperthermia for locally advanced rectal cancer treated with preoperative radiochemotherapy.Int J Hyperthermia,2011,27(5):482-490.
7. 米登海,李征,楊克虎,等.熱放化三聯療法治療非小細胞肺癌的Meta分析.中國循證醫學雜志,2011,11(11):1262-1267.
8. 米登海,李征,楊克虎,等.熱化放三聯療法治療食管癌的Meta分析.實用腫瘤雜志,2013,28(1):28-35.
9. Guyatt GH,Oxman AD,Kunz R,et al.GRADE guidelines:8.Rating the quality of evidence--indirectness.J Clin Epidemiol,2011,64(12):1303-1310.
10. Higgins JPT,Green S.Cochrane Handbook for Systematic Reviews of Interventions Version 5.1.0[updated March 2011].The Cochrane Collaboration,2011.Available at:www.cochrane.org/training/cochrane-handbook.
11. 喻志沖,袁洪香,王賀芳.局部晚期直腸癌綜合治療療效分析.中國臨床醫學,2003,10(6):851,853.
12. Kouloulias V,Plataniotis G,Kouvaris J,et al.Chemoradiotherapy combined with intracavitary hyperthermia for anal cancer:feasibility and long-term results from a phase II randomized trial.Am J Clin Oncol,2005,28(1):91-99.
13. 趙軍,王寶中,盛延興,等.放化療結合相控陣聚焦熱療治療直腸癌術后局部區域復發的臨床觀察.中華腫瘤防治雜志,2009,16(21):1691-1693.
14. 代素梅,盧玉娟,劉洪敏,等.三維適形放射治療同步化療聯合熱療對局部晚期及術后局部復發直腸癌近期療效的研究.現代預防醫學,2011,38(10):1996-1997,1999.
15. 沈雄虎,金永民,張松男,等.術前放療、化療聯合熱療治療直腸癌局部復發的臨床分析.現代預防醫學,2011,38(19):4023-4024.
16. Schroeder C,Gani C,Lamprecht U,et al.Pathological complete response and sphincter-sparing surgery after neoadjuvant radiochemotherapy with regional hyperthermia for locally advanced rectal cancer compared with radiochemotherapy alone.Int J Hyperthermia,2012,28(8):707-714.
17. 胡金飛,王道榮.新輔助放化療聯合熱療治療進展期直腸癌的臨床效果和安全性.中國醫藥導報,2013,10(30):64-66,70.
18. 溫本,鄭文滔,顏勁,等.新輔助放化療熱療聯合腹腔鏡手術治療進展期直腸癌的臨床療效.中國腫瘤臨床與康復,2013,20(11):1270-1272.
19. 鄧微.進展期直腸癌新輔助放化療加熱療的療效分析.中國保健營養(中旬刊),2014,4(24):2549.
20. 詹宏杰,梁寒.腫瘤熱療的研究.國外醫學(腫瘤學分冊),2005,32(1):35-38.
21. Falk MH,Issels RD.Hyperthermia in oncology.Int J Hyperthermia,2001,17(1):1-18.
22. vander Zee J.Heating the patient:a promising approach? Ann Oncol,2002,13(8):1173-1184.
23. de Haas-Kock DF,Buijsen J,Pijls-Johannesma M,et al.Concomitant hyperthermia and radiation therapy for treating locally advanced rectal cancer.Cochrane Database Syst Rev,2009,(3):CD006269.
24. 頡寶平,李征,姚南,等.化療聯合熱療治療晚期大腸癌療效及安全性的Meta分析.中國循證醫學雜志,2013,13(3):352-357.
25. 張娜,朱遠.腫瘤熱放療、化療在直腸癌治療中的研究進展.實用腫瘤雜志,2008,23(6):586-590.
26. Rau B,Wust P,Tilly W,et al.Preoperative radiochemotherapy in locally advanced or recurrent rectal cancer:regional radiofrequency hyperthermia correlates with clinical parameters.Int J Radiat Oncol Biol Phys,2000,48(2):381-391.
27. Ichikawa D,Yamaguchi T,Yoshioka Y,et al.Prognostic evaluation of preoperative combined treatment for advanced cancer in the lower rectum with radiation,intraluminal hyperthermia,and 5-fluorouracil suppository.Am J Surg,1996,171(3):346-350.
28. Wust P,Rau B,Gellerman J,et al.Radiochemotherapy and hyperthermia in the treatment of rectal cancer.Recent Results Cancer Res,1998,146:175-191.
29. Asao T,Sakurai H,Harashima K,et al.The synchronization of chemotherapy to circadian rhythms and irradiation in pre-operative chemoradiation therapy with hyperthermia for local advanced rectal cancer.Int J Hyperthermia,2006,22(5):399-406.
30. Milani V,Pazos M,Issels RD,et al.Radiochemotherapy in combination with regional hyperthermia in preirradiated patients with recurrent rectal cancer.Strahlenther Onkol,2008,184(3):163-168.
31. Schulze T,Wust P,Gellermann J,et al.Influence of neoadjuvant radiochemotherapy combined with hyperthermia on the quality of life in rectum cancer patients.Int J Hyperthermia,2006,22(4):301-318.
32. Bruggmoser G,Bauchowitz S,Canters R,et al.Quality assurance for clinical studies in regional deep hyperthermia.Strahlenther Onkol,2011,187(10):605-610.

Chinese Journal of Evidence-Based Medicine

Efficacy and Safety of Hyperthermo-Chemo-Radiotherapy for Rectal Cancer: A Systematic Review

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