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Oxaliplatin/fluorouracil‐based adjuvant chemotherapy for locally advanced rectal cancer after neoadjuvant chemoradiotherapy and surgery: a systematic review and meta‐analysis of randomized controlled trials
Author(s) -
Zhao L.,
Liu R.,
Zhang Z.,
Li T.,
Li F.,
Liu H.,
Li G.
Publication year - 2016
Publication title -
colorectal disease
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.029
H-Index - 89
eISSN - 1463-1318
pISSN - 1462-8910
DOI - 10.1111/codi.13381
Subject(s) - medicine , oxaliplatin , fluorouracil , colorectal cancer , meta analysis , neoadjuvant therapy , randomized controlled trial , oncology , chemoradiotherapy , chemotherapy , adjuvant chemotherapy , surgery , cancer , breast cancer
Aim Previous randomized controlled trials and meta‐analyses have demonstrated the ineffectiveness of fluorouracil‐based adjuvant chemotherapy for patients with rectal cancer who have undergone neoadjuvant chemoradiotherapy and subsequent surgery. The role of oxaliplatin/fluorouracil‐based adjuvant chemotherapy in such patients is unknown. We performed a meta‐analysis to evaluate the efficacy of oxaliplatin/fluorouracil‐based adjuvant chemotherapy based on a comparison with fluorouracil‐based adjuvant chemotherapy for patients with rectal cancer. Method A literature search of MEDLINE , Embase, Web of Science, Cochrane Library and ClinicalTrials.gov was performed to identify eligible studies. The primary end‐point of interest was disease‐free survival ( DFS ). The secondary end‐points were overall survival, compliance and the incidence of Grade 3 or 4 toxicity. Results The literature search identified four randomized controlled trials that met the inclusion criteria for the meta‐analysis, and 2793 patients with pathological TNM or clinical TNM Stage II or III disease were included. The meta‐analysis showed that oxaliplatin/fluorouracil‐based adjuvant chemotherapy was associated with a significantly improved DFS (hazard ratio 0.85; 95% CI 0.73−0.98; P = 0.03), comparable compliance ( OR 1.18; 95% CI 0.95−1.46; P = 0.13) and a higher incidence of vomiting or nausea ( OR 2.47; 95% CI 1.21−5.05; P = 0.01). No significant differences were observed between the groups with respect to overall survival and the incidence of leucopaenia, anaemia, thrombocytopaenia and diarrhoea. Conclusion Adjuvant oxaliplatin/fluorouracil‐based chemotherapy can improve the DFS of patients after neoadjuvant chemoradiotherapy and radical surgery, compared with adjuvant fluorouracil‐based chemotherapy. Data of the longer‐term survival outcome are needed.