The effect of neoadjuvant radiotherapy on colorectal cancer : a systematic review

Abstract

Background: Colorectal cancer is one of the common form of cancer in Hong Kong. Neoadjuvant radiotherapy is used to reduce the size of the tumour to achieve better treatment outcome. Previous studies on reducing local recurrence are positive, but improvement in survival still remains controversial.

Study Objective: To systematically review the effect of neoadjuvant radiotherapy for patients with colorectal cancer.

Method: Systematic review of relevant Randomised Controlled Trials (RCT) using electronic databases PubMed and Cochrane Library. The articles were retrieved through a screening process by hand. RCTs that have compared the effect of neoadjuvant radiotherapy on patients’ survival were included. Data were extracted and pooled for analysis.

Results: Nine RCTs were included in this review. The characteristics of the trials, the patients of each trial, treatment assignments, effect of treatment and the quality of each trial were summarised. Benefit in survival cannot be seen in patients assigned to radiotherapy compared to the surgery only group.

Conclusion: Neoadjuvant radiotherapy do not show a beneficial effect on patients with colorectal cancer. This result shows consistency with previous studies. Despite a potential benefit in local recurrence, the lack of evidence of survival improvement places the treatment in a less preferred position. Decision analysis should be performed to carefully weight out the cost, adverse effect from the treatment and its benefit.