To Explore the Efficacy and Safety of Neoadjuvant Chemoradiation Therapy in Locally Advanced Colon Cancer: A Systematic Review and Meta-analysis.

Abstract

The aim of this study was to systematically evaluate the efficacy and safety of neoadjuvant chemoradiation therapy (NCRT) in locally advanced colon cancer (LACC). PubMed, Embase, Web of Science, Cochrane Library, and ClinicalTrials.gov databases were searched to review relevant studies on NCRT for LACC published publicly from January 1, 2000 to October 31, 2024. Literatures were screened according to the inclusion and exclusion criteria, quality assessment was performed on those that met the criteria, and meta-analysis were performed using Stata 15.0 software after extracting relevant data. Eleven studies with a total of 698 patients with LACC treated with NCRT were finally included in the analysis. This meta-analysis revealed that patients achieved an R0 resection rate of 92% (95% confidence interval [CI], 88%-96%). In terms of tumor regression, the pathological complete response rate was 20% (95% CI, 16%-25%) and the major pathological response rate was 50% (95% CI, 36%-64%). In the aspect of organ preservation, the overall organ preservation rate was 53% (95% CI, 46%-60%), whereas the rate for patients with bladder involvement reached 87% (95% CI, 73%-100%). Regarding postoperative recurrence or metastasis, patients had a local recurrence rate of 10% (95% CI, 6%-13%) and a distant metastasis rate of 21% (95% CI, 14%-27%). Neoadjuvant radiation therapy (NRT) has shown survival benefits in LACC, improving 5-year overall survival with an hazard ratio of 1.42 (95% CI, 1.1-1.82) compared with non-NRT regimens. With respect to safety, the incidence of grade ≥3 adverse events after NCRT was 14% (95% CI, 9%-19%), with gastrointestinal reactions accounting for 6% (95% CI, 3%-9%) and postoperative anastomotic fistula occurring in 3% (95% CI, 0%-5%). This meta-analysis preliminarily reveals that NCRT demonstrates favorable efficacy and safety in LACC.