Total Neoadjuvant Therapy in Comparison with Conventional Treatment in the Management of Rectal Adenocarcinoma: A Systematic Review and Meta-analysis

Authors

Parisa Mousavi 1Student Research Committee, Sabzevar University of Medical Sciences, Sabzevar, Iran.
Alireza Ghorbani Cellular and Molecular Research Center, Sabzevar University of Medical Sciences, Sabzevar, Iran.
Parisa Rabiei Cancer Research Center, Mashhad University of Medical Sciences, Mashhad, Iran.
Pejman Porouhan Assistant Professor, Department of Radiation Oncology, Vasee Hospital, Sabzevar University of Medical Sciences, Sabzevar, Iran.
Babak Peyroshabany Assistant Professor, Department of Internal Medicine, Sabzevar University of Medical Sciences, Sabzevar, Iran.
Maryam Anvary Assistant Professor, Department of Internal Medicine, Mashhad University of Medical Sciences, Mashhad, Iran.
Mehdi Molavi Assistant Professor, Cellular and Molecular Research Center, Sabzevar University of Medical Sciences, Sabzevar, Iran.
Maryam Mahdlo Assistant Professor, Department of Internal Medicine, Sabzevar University of Medical Sciences, Sabzevar, Iran.
James S Welsh Loyola University Chicago Stritch School of Medicine, Edward Hines Jr., VA Hospital, Department of Radiation Oncology Maywood, IL, USA.
Sara Shenavaei Zare Assistant Professor, Cellular and Molecular Research Center Sabzevar University of Medical Sciences, Sabzevar, Iran.
Iman Jalalimehr Assistant Professor, Non-Communicable Diseases Research Center, Sabzevar University of Medical Sciences, Sabzevar, Iran.
Seyed Alireza Javadinia Assistant Professor, Non-Communicable Diseases Research Center, Sabzevar University of Medical Sciences, Sabzevar, Iran.
Fahimeh Attarian Cellular and Molecular Research Center Sabzevar University of Medical Sciences, Sabzevar, Iran.

Keywords:

induction chemotherapy, neoadjuvant chemoradiotherapy, adjuvant chemotherapy, rectal adenocarcinoma, Total neoadjuvant therapy

Abstract

Aim: This systematic review and meta-analysis aimed to compare total neoadjuvant therapy vs conventional treatment in the management of rectal adenocarcinoma.

Methods: Seventeen high quality Randomization Clinical Trial studies with 8019 individual data, were entered in meta-analysis study, which reported 3 year DFS and/or OS in rectal adenocarcinoma patients. Pooled estimates of 3 year DFS and OS for various approach of treatment were obtained by calculating the weighted percent from studies.

Results: The pooled estimates of DFS and OS rate during of 36 month follow up was 0.69 (0.95 CI 0.68, 0.70) and 0.83(0.95 CI 0.83, 0.85) to 6 type treatment approach in rectal adenocarcinoma patients. Subgroup analysis shows higher and lower overall DFS rate was 0.73 (0.95 CI 0.65, 0.79) for two approach (CT-CRT-S and CRT-CT-S) and 0.645 (0.95 CI 0.59, 0.70) (RT-CT-S). also higher and lower 3 year OS rate were 0.92 (0.95 CI 0.86. 0.95) in CRT-CT-S and 0.80 (0.95 CI 0.78, 0.83) in CRT-S approach (p<0.05).

Discussion: PCR and sphincter preservation are the most frequently reported outcome benefits of TNT in various trials. However, due to the heterogeneous patient populations in each study, which include high-risk features and differing treatment schedules, the survival advantage is not universally applicable. Therefore, the decision to use TNT should be tailored to the individual patient and made within a multidisciplinary framework. Despite this uncertainty, the use of TNT in rectal cancer continues to be explored as a means of enhancing patient outcomes and improving quality of life.