Consolidation chemotherapy might improve pathological complete response for locally advanced rectal cancer after neoadjuvant chemoradiation therapy: a meta‐analysis

Patients with locally advanced rectal cancer who achieve a pathological complete response (pCR) to neoadjuvant chemoradiation therapy (CRT) have an improved prognosis. The need for surgery in these patients has been questioned; however, the proportion of patients who achieve pCR and receive a wait‐and‐watch strategy is small. This meta‐analysis aimed to evaluate whether neoadjuvant consolidation chemotherapy leads to a higher rate of pCR than standard CRT alone in patients with locally advanced rectal cancer. To this end, we carried out a meta‐analysis of three clinical controlled trials, consisting of 466 patients who were divided into the CRT group ( n  = 211) and the consolidation chemotherapy group ( n  = 255). The results showed that consolidation chemotherapy could significantly improve the pCR rate compared with neoadjuvant CRT alone (pooled odds ratio for pCR 2.02, 95% confidence interval 1.09–3.57, P  = 0.03) and did not increase the adverse events (odds ratio 1.38, 95% confidence interval 0.77–2.50, P  = 0.28 for grades 1–2; odds ratio 0.92, 95% confidence interval 0.14–6.13, P  = 0.93 for grades 3–4). The findings of our study showed that adding consolidation chemotherapy after CRT is a safe approach that could lead to a higher pCR rate in patients with locally advanced rectal cancer.