Pre‐operative chemoradiation for non‐metastatic locally advanced rectal cancer

Kathryn McCarthy; Katherine Pearson; Rachel Fulton; Jonathan Hewitt

doi:10.1002/14651858.CD008368.pub2

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Figure 1

Forest plot of comparison: 1 Primary Outcome Parameters, outcome: 1.1 Overall Survival.

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Figure 2

Forest plot of comparison: 1 Primary outcome: 1.2 Local Recurrence CRT versus RT.

Due to potential interaction identified by the Bosset study authors this analysis does not include participants who underwent post‐operative chemotherapy.

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Figure 3

Forest plot of comparison: 2 Secondary Outcome Parameters, outcome: 2.1 30 Day Mortality CRT versus RT.

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Figure 4

Forest plot of comparison: 2 Secondary Outcome Parameters, outcome: 2.2 Sphincter Preservation CRT versus RT.

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Figure 5

Forest plot of comparison: 2 Secondary Outcome Parameters, outcome: 2.3 Acute Toxicity CRT versus RT.

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Figure 6

Forest plot of comparison: 2 Secondary Outcome Parameters, outcome: 2.4 Late Toxicity CRT versus RT.

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Analysis 1.1

Comparison 1 Primary Outcome Parameters, Outcome 1 Overall Survival.

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Analysis 1.2

Comparison 1 Primary Outcome Parameters, Outcome 2 Local Recurrence.

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Analysis 2.1

Comparison 2 Secondary Outcome Parameters, Outcome 1 30 Day Mortality.

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Analysis 2.2

Comparison 2 Secondary Outcome Parameters, Outcome 2 Sphincter Preservation.

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Analysis 2.3

Comparison 2 Secondary Outcome Parameters, Outcome 3 Acute Toxicity.

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Analysis 2.4

Comparison 2 Secondary Outcome Parameters, Outcome 4 Late Toxicity.

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Table 1. TNM classification of rectal cancer.

Tumour
T1	Tumour invades submucosa.
T2	Tumour invades muscularis propria.
T3	Tumour invades through to subserosa or into perirectal tissues.
T4	Tumour invades into surrounding structures/organs.
Nodes
N0	no lymph nodes involved.
N1	1‐3 local lymph nodes involved.
N2	>4 lymph nodes involved.
Metastases
M0	no distant metastases.
M1	Distant metastases.

Table 1. TNM classification of rectal cancer.

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Table 2. Staging of rectal cancer.

	Stage	Dukes classification	5 year survival (%)
T1‐2N0M0	I	A	80
T3N0M0	IIA	B	40‐60
T4N0M0	IIB	B	40‐60
T1‐2N1M0	IIIA	C	40
T3‐4N1M0	IIIB	C	30
TanyN2M0	IIIC	C	12
TanyNanyM1	IV	D	15 (2 year survival)

Table 2. Staging of rectal cancer.

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Table 3. Toxicity; Outcome measures and results

Study	Outcome Measure(s)	CRT	RT
Bujko 2006	Toxicity was measured using the Radiation Therapy Oncology Group/European Organisation for Research and Treatment of Cancer (EORTC) scale grade III‐IV. Toxicity was classified as late toxicity if it occurred more than 30 days after surgery.	18.2%	3.2%
Ngan 2007	One or more adverse early event. Published in abstract form so limited information currently available.	28%	1.9%
Gerard 2006	Early grade III‐IV toxicity, assessed using the WHO scale.	14.6%	2.7%
Bosset 2004 Patients enrolled before January 2001, n=798	Grade II toxicity assessed using the WHO acute morbidity scale or the occurrence of acute diarrhoea.	34.3%	17.3%

Table 3. Toxicity; Outcome measures and results

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Comparison 1. Primary Outcome Parameters

Outcome or subgroup title	No. of studies	No. of participants	Statistical method	Effect size
1 Overall Survival Show forest plot	4	2312	Odds Ratio (M‐H, Fixed, 95% CI)	1.01 [0.85, 1.20]

2 Local Recurrence Show forest plot	5	2138	Odds Ratio (M‐H, Fixed, 95% CI)	0.56 [0.42, 0.75]

Comparison 1. Primary Outcome Parameters

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Comparison 2. Secondary Outcome Parameters

Outcome or subgroup title	No. of studies	No. of participants	Statistical method	Effect size
1 30 Day Mortality Show forest plot	3	1568	Odds Ratio (M‐H, Fixed, 95% CI)	1.73 [0.88, 3.38]

2 Sphincter Preservation Show forest plot	4	2148	Odds Ratio (M‐H, Fixed, 95% CI)	1.01 [0.86, 1.20]

3 Acute Toxicity Show forest plot	4	2178	Odds Ratio (M‐H, Fixed, 95% CI)	3.96 [3.03, 5.17]

4 Late Toxicity Show forest plot	2	638	Odds Ratio (M‐H, Fixed, 95% CI)	0.88 [0.50, 1.54]

Comparison 2. Secondary Outcome Parameters

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