Meta-analysis of Efficacy and Safety of Total Neoadjuvant Therapy Compared with Neoadjuvant Chemoradiotherapy for Locally Advanced Rectal Cancer

Abstract

Objective: To systematically evaluate the efficacy and safety of total neoadjuvant therapy (TNT) compared with neoadjuvant chemoradiotherapy (nCRT) in the treatment of locally advanced rectal cancer. Methods: English databases (PubMed, Embase, Cochrane Central Register of Controlled Trials) and Chinese databases (China National Knowledge Infrastructure, Wanfang Database, China Biology Medicine Disc) were searched for literature on TNT combined with total mesorectal excision (TME) compared with nCRT combined with TME for the treatment of locally advanced rectal cancer. The literature search time limit was from the establishment of the database to October 2022. Two researchers independently screened the literature, extracted data, and preliminarily evaluated the quality of the literature. Meta-analysis was performed using Review Manager 5.4 software. Results: A total of 9 studies involving 1307 patients were included, including 668 patients in the experimental group and 639 patients in the control group. The results of the meta-analysis on survival benefits showed that the overall survival and pathological complete response rate of the experimental group were significantly better than those of the control group, with statistical significance (all, P<0.05); There was no statistical significance in the R0 resection rate and T stage downstaging rate between the two groups (all, P<0.05). The results of the meta-analysis on treatment safety showed that there was no statistically significant difference in the incidence of grade ≥3 adverse reactions and postoperative complications between the two groups (all, P>0.05). Conclusion: In the treatment of locally advanced rectal cancer, compared with the nCRT regimen, the TNT regimen can bring more survival benefits to patients without significantly increasing the risk of adverse reactions. It is recommended that TNT be used as a recommended treatment for patients with locally advanced rectal cancer.