Portal de Periódicos da CAPES

Impact of preoperative chemoradiation with higher dose intensity modulated radiotherapy on pathological complete response for locally advanced rectal cancer: a systematic review

2022; Taylor & Francis; Volume: 22; Issue: 11 Linguagem: Inglês

10.1080/14737140.2022.2130895

1744-8328

Roberta Carbonara, Alessia Surgo, Maria Paola Ciliberti, Fabiana Gregucci, Ilaria Bonaparte, Luca Nicosia, Elisa Meldolesi, Morena Caliandro, Valentina Ferraro, Riccardo Inchingolo, Riccardo Memeo, Elena Ludovico, Roberto Calbi, Mariadea Lavalle, Maria Antonietta Gambacorta, Filippo Alongi, Alba Fiorentino,

Colorectal Cancer Screening and Detection

Neoadjuvant chemoradiation (CRT) followed by total mesorectal excision is the current standard-of-care for locally advanced UICC II-III stage rectal cancer (LARC). A pathological complete response (pCR) correlates with survival. Improvements of pCR, including dose escalation, should be explored. The aim of this explorative analysis is to assess the impact on pCR of intensity-modulated radiotherapy (IMRT) with simultaneous integrated boost (SIB).A literature search via PICO (Population, Intervention, Comparison, Outcome) in MEDLINE/PubMed and EMBASE and a systematic review according to PRISMA (Preferred Reporting Items for Systematic Reviews and Metanalysis) methodology were performed. Studies that reported pCR rate in patients with LARC in clinical stage T2N+M0 or cT3/4 N0/+M0 treated with preoperative CRT with SIB-IMRT/VMAT (Volumetric Modulated Arc Therapy) were included. Sixty-two studies were identified, but only eight clinical trials with a total of 311 patients were included . Median follow-up was 16-61 months. pCR reached the value of 38%. Good survival outcomes were observed with a mild toxicity profile.Radiotherapy dose intensification in LARC showed a slight increase of pCR compared to historical studies. Prospective evaluations are necessary to define which patients would benefit most.