Preoperative chemoradiation vs radiation alone for stage II and III resectable rectal cancer: a meta-analysis

Aim The aim of this systematic literature review and meta-analysis was to compare preoperative radiotherapy (RT) with preoperative chemoradiotherapy (ChRT) in patients with stage II and III resectable rectal cancer. Method A comprehensive PubMed, Cohrane and Ovid electronic database search was performed. Articles published during the period 1960-2007 were included. The analysis included only randomized controlled trials, where patients with stage II and 111 resectable rectal cancer were randomized to one of at least two schedules of preoperative therapy including RT or ChRT followed by surgery. Secondary estimates for the experimental ChM" group were calculated and compared with the estimates pooled from trials which included short-course radiotherapy (SRT). Results We identified 1017 articles including 242 clinical trials, 65 of which were randomized studies. Five trials from these randomized studies compared preoperative RT with conventional ChRT and only one included a group having SRT. The complete response rate was significantly better after preoperative chemoradiation compared with preoperative RT alone but the rate of toxicity was higher. Theoretically higher curative resection rates with less morbidity were found after ChRT compared with preoperative SRT. Conclusion Preoperative ChRT for patients with stage II and III resemble rectal cancer gives better complete response rates compared with RT alone but it also results in higher toxicity.