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

Authors
 Jeongshim Lee  ;  Chul Yong Kim  ;  Woong Sub Koom  ;  Chai Hong Rim 
Citation
 RADIOTHERAPY AND ONCOLOGY, Vol.140 : 10-19, 2019 
Journal Title
 RADIOTHERAPY AND ONCOLOGY 
ISSN
 0167-8140 
Issue Date
2019
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.
Full Text
https://www.sciencedirect.com/science/article/pii/S0167814019329226
DOI
10.1016/j.radonc.2019.05.021
Appears in Collections:
1. College of Medicine (의과대학) > Dept. of Radiation Oncology (방사선종양학교실) > 1. Journal Papers
Yonsei Authors
Koom, Woong Sub(금웅섭) ORCID logo https://orcid.org/0000-0002-9435-7750
Lee, Jeong Shim(이정심)
URI
https://ir.ymlib.yonsei.ac.kr/handle/22282913/173162
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