Adjuvant chemotherapy after neoadjuvant chemo-radiotherapy and surgery in locally advanced rectal cancer. A systematic review of literature with a meta-analysis of randomized clinical trials

• Published in: Critical reviews in oncology/hematology Vol. 172; p. 103627
• Main Authors: Tamburini, Emiliano, Tassinari, Davide, Ramundo, Matteo, De Stefano, Alfonso, Viola, Massimo Giuseppe, Romano, Carmela, Elia, Maria Teresa, Zanaletti, Nicoletta, Rudnas, Britt, Casadei-Gardini, Andrea, Delrio, Paolo, Toma, Ilaria, Granata, Vincenza, Petrucelli, Luciana, Avallone, Antonio
• Format: Journal Article
• Language: English
• Published: Netherlands Elsevier B.V 01-04-2022
• Subjects: Adjuvant chemotherapy; Antineoplastic Combined Chemotherapy Protocols - therapeutic use; Chemoradiotherapy; Chemotherapy, Adjuvant; Fluoropyrimidine; Fluorouracil; FOLFOX XELOX; Humans; Neoadjuvant Therapy; Neoplasm Staging; Oxaliplatin; Randomized Controlled Trials as Topic; Rectal cancer; Rectal Neoplasms - pathology; Rectal Neoplasms - therapy; Adjuvant chemotherapy; Oxaliplatin; FOLFOX XELOX; Rectal cancer; Fluoropyrimidine
• ISSN: 1040-8428; 1879-0461
• DOI: 10.1016/j.critrevonc.2022.103627

Although no definitive data exist in literature, adjuvant chemotherapy is usually recommended in patients with radically resected stage III rectal cancer treated with neo-adjuvant chemo-radiotherapy. We performed a systematic review of literature with direct and indirect comparisons to assess the role of adjuvant mono- or poli-chemotherapy in radically resected rectal cancer treated with neoadjuvant chemo-radiotherapy. Neither chemotherapy (mono-or poli-chemotherapy) nor polichemotherapy with oxaliplatin-containing regimens seems to improve Overall Survival and Disease-Free Survival in patients with radically resected rectal cancer treated with neoadjuvant chemo-adiotherapy. Neither the entire population of patients radically resected after neoadjuvant chemotherapy, nor high risk patients seem to benefit from adjuvant chemotherapy. Our data seem to suggest the need of review the actual international guidelines that suggest the need of adjuvant chemotherapy at least in high risk rectal cancer treated with surgery and neoadjuvant chemo-radiotherapy.
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•Although no definitive data exist in literature, adjuvant chemotherapy is usually recommended in patients with radically resected stage III rectal cancer treated with neo-adjuvant chemo-radiotherapy.•We performed a systematic review of literature with direct and indirect comparisons to assess the role of adjuvant mono- or poli-chemotherapy in radically resected rectal cancer treated with neoadjuvant chemo-radiotherapy.•Neither chemotherapy (mono-or poli-chemotherapy) nor polichemotherapy with oxaliplatin-containing regimens seems to improve Overall Survival and Disease-Free Survival in patients with radically resected rectal cancer treated with neoadjuvant chemo-adiotherapy.•Our data seem to suggest the need of review the actual international guidelines that suggest the need of adjuvant chemotherapy at least in high risk rectal cancer treated with surgery and neoadjuvant chemo-radiotherapy.