Preoperative Radiotherapy in Patients with Gastric and Gastro-Oesophageal Cancer: A Systematic Review and Meta-analysis.

IF 1.6 Q4 ONCOLOGY
Gustavo Tadeu Freitas Uchôa Matheus, Pedro Henrique de Souza Wagner, João Arthur Cerqueira Taumaturgo, Shi Juin Lam, Francisco Cezar Aquino de Moraes
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引用次数: 0

Abstract

Background: Gastric (GC) and gastroesophageal junction (GEJ) cancers are among the most prevalent digestive cancers, characterized by a poor prognosis, particularly in advanced stages, where the 5-year survival rate remains below 20%. While surgery is still the standard treatment, its limited ability to lower recurrence rates highlights the necessity for effective perioperative therapies. In this context, Radiotherapy (RT) and chemoradiotherapy (CRT) have been investigated for their potential to improve tumor control, pathologic complete response (pCR), and overall survival (OS) in advanced GC. This systematic review and meta-analysis aimed to assess the efficacy and safety of preoperative RT/CRT on key clinical outcomes in patients with GC, focusing on pathologic complete response (pCR), overall survival (OS), and postoperative complications, such as anastomotic leaks and postoperative mortality.

Methods: A systematic search of PubMed, Embase, and Web of Science databases was conducted for randomized controlled trials and single-arm studies comparing preoperative RT/CRT with chemotherapy or surgery alone. Outcomes were pooled using risk ratios (RRs) or hazard ratios (HRs) with 95% confidence intervals (CIs), and heterogeneity was assessed using I2 statistics. Furthermore, quality assessment was performed using RoB 2 and ROBINS-I tools. We also utilized tools to enhance the interpretation and understanding of the meta-analysis results, including GRADE, the leave-one-out method, Baujat and Doi plots.

Results: Ten studies including 6 RCTs and 4 single-arm studies, comprising 2,138 patients were included. CRT significantly improved pCR rates compared to control groups (RR 2.72; 95% CI 1.89-3.92; p < 0.000001; I2 = 0%), with a pCR rate of 21% in single-arm analysis. No statistical significance was observed in the hazard ratio analysis for OS (HR 0.84; 95% CI 0.65-1.10; p = 0.209; I2 = 67%), including the subgroup analyses at three (RR 1.15; 95% CI 0.93-1.43; p = 0.183; I2 = 70%) and five years (RR 1.23; 95% CI 1.00-1.51; p = 0.051; I2 = 58%). Moreover, the rates for anastomotic leaks (RR 0.86; 95% CI 0.66-1.14; p = 0.294; I2 = 0%) and postoperative mortality (RR 0.88; 95% CI 0.46-1.70; p = 0.71; I2 = 25%) showed no significant differences between groups, with low event rates in single-arm studies, 7% and 3%, respectively.

Conclusion: Preoperative CRT significantly improves pCR rates, highlighting its potential as a valuable strategy in tumor downstaging. However, it does not enhance survival outcomes, while notably, it does not increase surgical complications. Future studies incorporating biomarkers and standardized protocols are essential to refine patient selection, ensuring optimized treatment strategies and maximizing clinical benefits.

胃癌和胃食管癌患者术前放疗:系统回顾和荟萃分析。
背景:胃(GC)和胃食管交界处(GEJ)癌是最常见的消化道癌症之一,其特点是预后差,特别是在晚期,其5年生存率仍低于20%。虽然手术仍然是标准的治疗方法,但其降低复发率的能力有限,强调了有效的围手术期治疗的必要性。在这种背景下,放疗(RT)和放化疗(CRT)已经被研究了它们在改善晚期胃癌肿瘤控制、病理完全缓解(pCR)和总生存(OS)方面的潜力。本系统综述和荟萃分析旨在评估术前RT/CRT对胃癌患者关键临床结局的疗效和安全性,重点关注病理完全缓解(pCR)、总生存期(OS)和术后并发症,如吻合口漏和术后死亡率。方法:系统检索PubMed, Embase和Web of Science数据库,进行随机对照试验和单臂研究,比较术前RT/CRT与化疗或单独手术。采用95%置信区间(ci)的风险比(rr)或危险比(hr)汇总结果,并采用I2统计量评估异质性。此外,使用rob2和ROBINS-I工具进行质量评估。我们还使用了工具来加强对meta分析结果的解释和理解,包括GRADE、留一法、Baujat和Doi图。结果:纳入10项研究,包括6项rct和4项单臂研究,共2138例患者。与对照组相比,CRT显著提高了pCR率(RR 2.72;95% ci 1.89-3.92;p 2 = 0%),单臂分析的pCR率为21%。OS的风险比分析无统计学意义(HR 0.84;95% ci 0.65-1.10;p = 0.209;I2 = 67%),包括3的亚组分析(RR 1.15;95% ci 0.93-1.43;p = 0.183;I2 = 70%)和5年(RR 1.23;95% ci 1.00-1.51;p = 0.051;i2 = 58%)。吻合口瘘发生率(RR 0.86;95% ci 0.66-1.14;p = 0.294;I2 = 0%)和术后死亡率(RR 0.88;95% ci 0.46-1.70;p = 0.71;I2 = 25%)组间无显著差异,单组研究的发生率较低,分别为7%和3%。结论:术前CRT显着提高pCR率,突出其作为肿瘤降分期有价值的策略的潜力。然而,它不会提高生存结果,同时值得注意的是,它不会增加手术并发症。结合生物标志物和标准化方案的未来研究对于改进患者选择,确保优化治疗策略和最大化临床效益至关重要。
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来源期刊
CiteScore
3.80
自引率
0.00%
发文量
121
期刊介绍: The Journal of Gastrointestinal Cancer is a multidisciplinary medium for the publication of novel research pertaining to cancers arising from the gastrointestinal tract.The journal is dedicated to the most rapid publication possible.The journal publishes papers in all relevant fields, emphasizing those studies that are helpful in understanding and treating cancers affecting the esophagus, stomach, liver, gallbladder and biliary tree, pancreas, small bowel, large bowel, rectum, and anus. In addition, the Journal of Gastrointestinal Cancer publishes basic and translational scientific information from studies providing insight into the etiology and progression of cancers affecting these organs. New insights are provided from diverse areas of research such as studies exploring pre-neoplastic states, risk factors, epidemiology, genetics, preclinical therapeutics, surgery, radiation therapy, novel medical therapeutics, clinical trials, and outcome studies.In addition to reports of original clinical and experimental studies, the journal also publishes: case reports, state-of-the-art reviews on topics of immediate interest or importance; invited articles analyzing particular areas of pancreatic research and knowledge; perspectives in which critical evaluation and conflicting opinions about current topics may be expressed; meeting highlights that summarize important points presented at recent meetings; abstracts of symposia and conferences; book reviews; hypotheses; Letters to the Editors; and other items of special interest, including:Complex Cases in GI Oncology:  This is a new initiative to provide a forum to review and discuss the history and management of complex and involved gastrointestinal oncology cases. The format will be similar to a teaching case conference where a case vignette is presented and is followed by a series of questions and discussion points. A brief reference list supporting the points made in discussion would be expected.
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