Objective To discuss the important role of preoperative chemoradiotherapy in the treatment of mid-low rectal cancer. Methods From the surgical point of view, the evidences from clinic trials in literatures of recent years and also from the results of our single institution were analyzed. Results Preoperative radiotherapy with total dosage of 50 Gy had showed more and more advantages in the past two decades. Preoperative radiotherapy with concomitant chemotherapy had definite effects in downing stage and improving local control, while its role in sphincter preserving kept in controversy. However, this combined preoperative therapies had not improved long-term survival in rectal cancer. By now, there were no proper indicators to predict the effects of therapies. Conclusion Preoperative chemoradiotherapy is still the only way to improve the rate of R0 resection and decrease the rate of local currence after surgery for patients with mid-low advanced rectal cancer.
Objective To explore the safety of neoadjuvant chemoradiotherapy combined with sphincter-preserving operation in treatment of locally advanced low rectal cancer. Methods The clinical data of thirty-four patients admitted into our hospital between June 2007 and June 2009 with T3 and T4 low rectal cancer treated by neoadjuvant chemoradiotherapy and sphincter-preserving operation were collected and analyzed retrospectively. Routine fraction of radiation was given with total dose of 40 Gy, five times a week, 2 Gy per fraction. Patients received oxaliplatin （150 mg/d1）, plus folinic (100 mg/d1-3) and 5FU (750 mg/d1-3) for total 1 cycles started from the 4th week of irradiation. Operation was performed 4 weeks after neoadjuvant therapy. Results After neoadjuvant therapy, all patients underwent surgical resection with average tumor size decreased by 41.2%, tumor T stage decreased in 67.6% （23/34) patients, and lymph nodenegative change rate was 58.8% (10/17). One patient had liver metastasis and one had local recurrence, but without stomal leak. And 88.2% (30/34) patients showed good function of sphincter. Conclusions Neoadjuvant chemoradiotherapy in advanced lower rectal cancer patients has shown its efficacy in down-staging, which is safe without increasing operation complications when combined with sphincterpreserving surgery.
Objective To evaluate the efficacy of preoperative concurrent chemoradiotherapy combined with total mesorectal excision （TME） in treatment for locally advanced lower rectal cancer. Methods The clinical data of 31 patients with locally advanced lower rectal cancer received concurrent chemoradiotherapy from January 2009 to December 2011 in this hospital were analyzed retrospectively. Conventional fraction radiotherapy with total dose 50 Gy and chemotherapy with mFOLFOX6 or CapeOX regimen were taken. The efficacy was assessed by recording results of clinical and pathological examination. The function of sphincter was also recorded. Results All 31 patients underwent TME operation. The complication morbidity and mortality was 12.9% （4/31） and 3.2% （1/31），respectively. As a result of the preoperative management，the tumor was reduced by an average of 21.9%， down-regulation of T stage was observed in 48.4% （15/31） patients，the frequency of lymph node metastasis decreased from 83.9% （26/31） to 38.7% （12/31）. Pathological complete response was observed in 5 patients （16.1%） and the total response rate was 74.2% （23/31），grade 3/4 toxicity was occurred in 2 （6.5%） patients. 84.6% （22/26） of patients underwent sphincter preservation surgery reserved good function of sphincter. Conclusions Preoperative concurrent chemoradiotherapy combined with TME in treatment for locally advanced lower rectal cancer is effective and safe，which can lead to pathological complete response，decrease the tumor stage and the rate of lymph node metastasis，and can also increase the efficacy of operation.
Objective To investigate efficacy and toxicity of XELOX or FOLFOX4 regimen as neoadjuvant concurrent chemoradiotherapy for stage Ⅱ/Ⅲ middle and low rectal cancer. Methods From June 2011 to March 2014, 120 patients with stage Ⅱ/Ⅲ middle and low rectal cancer who underwent the surgical treatment were enrolled in The Fifth People’s Hospital of Qinghai Province, then were randomly divided into radiotherapy+FOLFOX4 regimen group and radiotherapy+XELOX regimen group. The radiotherapy and chemotherapy were performed simultaneously before the radical resection of rectal cancer. Three-dimensional conformal radiotherapy: 1.8–2.0 Gy/times, 5 times/week, a total of 25 times, the total dose was 45.0–50.0 Gy. At the same time, 2 cycles of chemotherapy were performed according to the FOLFOX4 program (oxaliplatin+leucovorin+5-fluorouracil) or XELOX regimen (capecitabine tablet+oxaliplatin). The radical surgery was performed on 4 to 8 weeks after the preoperative chemoradiotherapy, then 8 to 12 cycles of FOLFOX4 chemotherapy and 4 to 6 cycles of XELOX chemotherapy were completed in the radiotherapy+FOLFOX4 regimen group and the radiotherapy+XELOX regimen group respectively on 1 month after the radical surgery. The curative effect and the occurrence of acute toxicity were observed. Results ① There were no significant differences in thegeneral data such as the gender, age, cT stage, cN stage, TNM stage, histological type, differentiation degree, etc. between the two groups(P>0.05). ② The reduced staging rates of cT and cN in the radiotherapy+XELOX regimen group was 63.3% (38/60) and 86.7% (52/60), respectively, which was significantly higher than that in the radiotherapy+FOLFOX4 regimen group〔38.3% (23/60) and 53.3% (32/60), respectively〕 , the differences were statistically significant (P<0.05). ③ The complete response rate and the effective rate (complete response rate+partial response rate) in the radiotherapy+XELOX regimen group were significantly higher than those in the radiotherapy+FOLFOX4 regimen group (P<0.05). ④ The overall 3-year survival rate in the radiotherapy+XELOX regimen group was significantly higher than that in the radiotherapy+FOLFOX4 regimen group (P<0.05). There were no significant differences in the 3-year disease-free survival rate, distant metastasis rate, and local recurrence rate between the two groups (P>0.05). ⑤ All the patients suffered from 3 to 4 degrees toxicities, however, the incidence rates of the overall toxicity and the diarrhea toxicity in the radiotherapy+XELOX regimen group were significantly lower than those in the radiotherapy+FOLFOX4 regimen group (P<0.05). Conclusion Preliminary results of limited cases in this study show that XELOX regimen is more effective and less acute toxicity than FOLFOX4 regimen for preoperative concurrent chemoradiotherapy for patients with stage Ⅱ/Ⅲ middle and low rectal cancer.
Objective To investigate the risk factors of liver metastasis in patients with middle and low rectal cancer of Ⅱ–Ⅲ stage after preoperative short course radiotherapy combined with chemotherapy. MethodsThe clinical data of 89 patients with middle and low rectal cancer of Ⅱ–Ⅲ stage admitted to the Dongnan Hospital of Xiamen University from January 2019 to June 2020 were retrospectively analyzed. All patients were treated with short-course radiotherapy combined with chemotherapy before operation. The risk factors of postoperative liver metastasis were analyzed by multivariate logistic regression. ResultsThe 89 patients were followed up for 7–53 months, with a median follow-up time of 33 months. During the follow-up period, 25 patients developed liver metastasis, the onset time was 7–35 months, and the median time of liver metastasis was 17 months. Among them, 5 patients (5.6%) developed liver metastasis in the first year after surgery, 15 patients (16.8%) developed liver metastasis at the second year after surgery, 5 patients (5.6%) developed liver metastasis at the 3rd year after surgery. Multivariate logistic regression results showed that lymph node metastasis [OR=3.550, 95%CI (1.425, 8.953), P=0.041], vascular invasion [OR=3.335, 95%CI (1.011, 11.001), P=0.048], maximum tumor diameter ≥5 cm [OR=4.477, 95%CI (1.273, 15.743), P=0.019], and peri-tumor diameter ≥1/2 [OR=4.633, 95%CI (1.387, 15.475), P=0.013] were risk factors for liver metastasis. ConclusionsLymph node metastasis, vascular invasion, maximum tumor diameter ≥5 cm, and circumferential tumor diameter ≥1/2 are risk factors for liver metastasis in patients with middle and low rectal cancer of Ⅱ–Ⅲ stage after preoperative short course radiotherapy combined with chemotherapy.
ObjectiveTo make a comprehensive review of the value of radiomics for prediction of therapeutic responses to neoadjuvant chemoradiotherapy (NCRT) in patients with locally advanced rectal cancer (LARC).MethodRelevant literatures about the therapeutic response evaluation of LARC by using radiomics were collected to make an review.ResultRadiomics had good predictive value in terms of complete pathologic response (pCR) and treatment effectiveness of NCRT in patients with LARC.ConclusionRadiomics, a new imaging diagnostic technique, plays an important role in the prediction of the efficacy of NCRT in LARC.
Objective To compare efficacy of laparoscopic surgery and open surgery in treatment of rectal cancer after neoadjuvant chemoradiotherapy. Methods The relevant literatures were retrieved from databases including CNKI, CBM, Wanfang, VIP, PubMed, Cochrane Library, and Embase from 2007 to 2017, all the relevant randomized controlled trial (RCT) or non-randomized controlled trial (NRCT) of laparoscopic surgery versus open surgery in patients with rectal cancer were collected according to the inclusion and exclusion criterial. Two reviewers independently screened the literatures, extracted the data, and assessed the bias risk of the included studies. Then, the meta-analysis was performed using RevMan 5.3 software. Results A total of 11 RCTs and 9 NRCTs involving 2 036 patients with rectal cancer were included, of these, including 1 021 cases of laparoscopic surgery and 1 015 cases of open surgery. The results of the meta-analysis showed that the operation time was increased ［WMD=14.21, 95% CI (1.92, 26.51)］, the intraoperative blood loss ［WMD=–38.96, 95% CI (–60.29, –7.63)］, first postoperative exhaust time ［WMD=–0.86, 95% CI (–1.14, –0.57)］, first postoperative intake food time ［WMD=–0.89, 95% CI (–1.15, –0.62)］, and postoperative hospitalization time ［WMD=–2.38, 95% CI (–3.44, –1.32)］ were reduced in the laparoscopic surgery as compared with the open surgery; the rate of the sphincter-saving was increased ［OR=2.35, 95% CI (1.67, 3.30)］, the rates of the local recurrence ［OR=0.25, 95% CI (0.13, 0.47)］, postoperative overall complications ［OR=0.34, 95% CI (0.26, 0.43)］, infection of incision ［OR=0.39, 95% CI (0.25, 0.62)］, intestinal obstruction ［OR=0.30, 95% CI (0.17, 0.53)］, lung infection ［OR=0.32, 95% CI (0.18, 0.57)］, and anastomotic fistula ［OR=0.40, 95% CI (0.22, 0.73)］ were decreased in the laparoscopic surgery as compared with the open surgery; the intraoperative lymph node resection ［WMD=–0.99, 95% CI (–2.11, 0.12)］, the rates of the 3-year disease-free survival ［OR=0.91, 95% CI (0.54, 1.54)］, pelvic infection ［OR=0.64, 95% CI (0.17, 2.45)］, anastomotic bleeding ［OR=0.54, 95% CI (0.22, 1.34)］, urinary retention ［OR=0.71, 95% CI (0.34, 1.48)］, and urinary tract infection ［OR=1.22, 95% CI (0.45, 3.30)］ had no significant differences between these two surgeries. Conclusion Laparoscopy surgery is still safer, more effective, and more reliable than conventional open surgery after neoadjuvant chemoradiotherapy in rectal cancer, but it needs more clinical RCTs to further provide accurate and reliable results.
Objective To evaluate the safety and efficacy of neoadjuvant therapy followed by minimally invasive esophagectomy (MIE) for locally advanced esophageal cancer. Methods We retrospectively analyzed clinical data of 56 consecutive patients with locally advanced esophageal cancer treated by neoadjuvant therapy followed by surgery in our hospital between January 2015 and December 2016. There were 51 males and 5 females. The patients were divided into 2 groups. Neoadjuvant therapy followed by open surgery esophagectomy group was as an OE group with 25 patients aged 61 (50-73) years. And neoadjuvant therapy followed by MIE was as a MIE group with 31 patients aged 60 (55-79) years. Results The pathologic complete response (pCR) rate of 28 patients with neoadjuvant concurrent chemoradiotherapy was significantly higher than that of 28 patients with neoadjuvant chemotherapy (21.4% vs. 10.7%, P<0.05). The operation time, intraoperative blood loss, R2 rate and the number of lymph nodes dissection in the MIE group were obviously better than those of the OE group with statistical differences (P<0.05). However, there was no significant difference in the number of resected lymph nodes along the bilateral recurrent laryngeal nerves and lymph node metastasis rate (P>0.05) between the two groups. The incidence of postoperative respiratory complications in the MIE group was lower than that of the OE group (P=0.041). There was no significant difference between the two groups in the incidence of other complications, re-operation, re-entry to ICU, median length of stay or perioperative deaths (P>0.05). There was only one patient with neoadjuvant concurrent chemoradiotherapy in the OE group died due to gastric fluid asphyxia caused by trachea-esophageal fistula. Conclusion Neoadjuvant therapy followed by MIE for locally advanced esophageal cancer is safe and feasible. The oncological outcomes seem comparable regardless of OE.
ObjectiveTo explore the best neoadjuvant treatment strategy for esophageal cancer and provide a theoretical basis for clinical formulation of neoadjuvant treatment plan. MethodsPubMed, EMbase, The Cochrane Library, Web of Science, CNKI, Wanfang, and VIP were searched from inception to May 2022. Two researchers independently performed literature screening and data extraction. The quality of the studies was evaluated by the Cochrane risk of bias tool, and data analysis was performed in RStudio environment using R3.6.3 software. ResultsA total of 24 studies were included, covering 5 286 patients treated with surgery alone, neoadjuvant chemotherapy (NCT), neoadjuvant radiotherapy (NRT), or neoadjuvant chemoradiotherapy (NCRT) followed by combined surgical treatment. The risk of bias of the studies was low. The results of the network meta-analysis showed that combined surgical treatments after NCRT [HR=0.77, 95%CI (0.70, 0.85)] and NCT [HR=0.89, 95%CI (0.81, 0.98)] were effective methods to improve patients' overall survival (OS) compared with surgery alone. In addition, NCRT could significantly reduce the incidence of local recurrence [OR=0.43, 95%CI (0.30, 0.58)] and distant metastasis [OR=0.71, 95%CI (0.52, 0.93)] in patients with esophageal cancer. However, NCRT [RR=1.30, 95%CI (0.77, 2.20)] increased the mortality rate of patients at 30 d after surgery. ConclusionThe available evidence suggests that NCRT combined with surgery is the best option for treating patients with resectable esophageal cancer, but this treatment carries the risk of increased 30 d postoperative mortality. Future studies should focus on optimizing the NCRT regimen with the aim of improving patients’ OS while effectively reducing postoperative mortality. In addition, more high-quality randomized controlled trials are needed to support the results of the study.
ObjectiveTo evaluate the efficacy and safety of concurrent chemoradiotherapy versus sequential chemoradiotherapy in the treatment of locally advanced non-small cell lung cancer. MethodsThe relevant literature was searched in PubMed, Web of Science, CNKI and Wanfang databases from the inception to October 15, 2023, and the literature was screened according to the inclusion and exclusion criteria. Review Manager 5.3 software was used for meta-analysis of the literature, and the Cochrane bias risk assessment tool was used to evaluate the quality of the literature. Results Finally, 14 randomized controlled studies were included covering a total of 1048 patients. The results of meta-analysis showed that the overall response rate [OR=2.39, 95%CI (1.83, 3.11)], 1-year survival rate [OR=1.81, 95%CI (1.39, 2.35)], 2-year survival rate [OR=1.75, 95%CI (1.27, 2.42)] and 3-year survival rate [OR=2.33, 95%CI (1.49, 3.66)] were superior to sequential chemoradiotherapy (P<0.001). In terms of safety, concurrent chemoradiotherapy increased the incidence of radiation esophagitis (P<0.05), but there was no statistical difference in the incidence of leukopenia and radiation pneumonia (P>0.05). Conclusion For patients with locally advanced non-small cell lung cancer, the short-term efficacy of concurrent chemoradiotherapy is better than that of sequential chemoradiotherapy and can improve the 1-, 2- and 3-year survival rates, but the toxic side effects of the treatment are slightly greater than those of the sequential chemoradiotherapy.