Practical effectiveness of re-irradiation with or without surgery for locoregional recurrence of rectal cancer: A meta-analysis and systematic review
- Authors
- Lee, Jeongshim; Kim, Chul Yong; Koom, Woong Sub; Rim, Chai Hong
- Issue Date
- Nov-2019
- Publisher
- ELSEVIER IRELAND LTD
- Keywords
- Rectal cancer; Recurrence; Re-irradiation; Surgery; Complication
- Citation
- RADIOTHERAPY AND ONCOLOGY, v.140, pp.10 - 19
- Indexed
- SCIE
SCOPUS
- Journal Title
- RADIOTHERAPY AND ONCOLOGY
- Volume
- 140
- Start Page
- 10
- End Page
- 19
- URI
- https://scholar.korea.ac.kr/handle/2021.sw.korea/62129
- DOI
- 10.1016/j.radonc.2019.05.021
- ISSN
- 0167-8140
- Abstract
- Background and purpose: Re-irradiation might yield local control (LC) or palliation for locoregionally recurrent rectal cancer (LRRC), but iatrogenic complications are a possible hindrance. We aimed to evaluate the efficacy of re-irradiation to determine optimal treatment of LRRC. Methods: We performed a systematic review of PubMed, MEDLINE, Cochrane Library, and Embase. Results: A total of 17 studies involving 744 patients with LRRC were included; median OS ranging from 10 to 45 months (median: 24.5 months). Pooled 1-, 2-, and 3-year OS rates for all patients were 76.1%, 49.1%, and 38.3%, respectively. For patients who underwent re-irradiation and surgery (OP group), these pooled rates were 85.9%, 71.8%, and 51.7%, respectively. For patients who underwent re-irradiation but not surgery (non-OP group), pooled 1-, 2-, and 3-year OS rates were 63.5%, 34.2%, and 23.8%, respectively. The OS difference between both groups was significant for all 3 years (P < 0.05). Pooled 1-, 2-, and 3-year LC rates for the OP group were 84.4%, 63.8%, and 46.9%, and for the non-OP group were 72.0%, 54.8%, and 44.6%, respectively, without significant differences. Pooled grade > 3 acute and late complication rates were 11.7% and 25.5% in the OP and non-OP groups, respectively. Patients who underwent surgery had a higher risk of grade > 3 late complications (odds ratio: 6.39). Pooled symptomatic palliation rate was 75.2%. Conclusions: Re-irradiation with or without surgery for LRRC showed oncologic and palliative efficacy. Salvage treatment including re-irradiation and surgery showed higher survival, but the late complication was significantly increased with concomitant surgery. (C) 2019 Elsevier B.V. All rights reserved.
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