Practical effectiveness of re-irradiation with or without surgery for locoregional recurrence of rectal cancer: A meta-analysis and systematic review

Jeongshim Lee, Chul Yong Kim, Woong Sub Koom, Chai Hong Rim

Research output: Contribution to journalReview article

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.

Original languageEnglish
Pages (from-to)10-19
Number of pages10
JournalRadiotherapy and Oncology
Volume140
DOIs
Publication statusPublished - 2019 Nov 1

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Rectal Neoplasms
Meta-Analysis
Recurrence
Salvage Therapy
PubMed
MEDLINE
Libraries
Re-Irradiation
Odds Ratio
Survival

Keywords

  • Complication
  • Re-irradiation
  • Rectal cancer
  • Recurrence
  • Surgery

ASJC Scopus subject areas

  • Hematology
  • Oncology
  • Radiology Nuclear Medicine and imaging

Cite this

Practical effectiveness of re-irradiation with or without surgery for locoregional recurrence of rectal cancer : A meta-analysis and systematic review. / Lee, Jeongshim; Kim, Chul Yong; Koom, Woong Sub; Rim, Chai Hong.

In: Radiotherapy and Oncology, Vol. 140, 01.11.2019, p. 10-19.

Research output: Contribution to journalReview article

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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.",
keywords = "Complication, Re-irradiation, Rectal cancer, Recurrence, Surgery",
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T1 - Practical effectiveness of re-irradiation with or without surgery for locoregional recurrence of rectal cancer

T2 - A meta-analysis and systematic review

AU - Lee, Jeongshim

AU - Kim, Chul Yong

AU - Koom, Woong Sub

AU - Rim, Chai Hong

PY - 2019/11/1

Y1 - 2019/11/1

N2 - 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.

AB - 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.

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KW - Re-irradiation

KW - Rectal cancer

KW - Recurrence

KW - Surgery

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