Abstract:
BACKGROUND:This review sets out to assess the efficacy of pre-operative chemoradiation when compared to radiotherapy alone before surgery in the treatment of advanced non metastatic rectal surgery. OBJECTIVES:To determine the efficacy of pre-operative chemoradiation (CRT) compared with radiation (RT) alone, in locally advanced rectal cancer with respect to overall survival, local recurrence and 30 day mortality, sphincter preservation and toxicity of treatment (both acute and late). SEARCH METHODS:In September 2011, we searched clinical trial registers, the Cochrane Central Register of Controlled Trials, Web of Science, EMBASE and MEDLINE and reviewed reference lists. Further hand searches were conducted of relevant journal proceedings. No language constraints were applied.The following search terms were used: colorectal, rectal, rectum, cancer, carcinoma, tumour, radiotherapy, chemotherapy, chemoradiotherapy, chemoradiation, 5-Fluorouracil, 5-FU, neo-adjuvant, preoperative, surgery, anterior resection, abdominoperineal resection, total mesorectal excision. SELECTION CRITERIA:Male and female patients aged over 18 years undergoing preoperative chemoradiation or radiotherapy followed by surgery for locally advanced non-metastatic rectal cancer. There was no upper age limit for participants. Locally advanced non-metastatic cancer was defined as stage 3 rectal tumours. These are tumours of any T stage with nodal involvement, without evidence of distant metastases. DATA COLLECTION AND ANALYSIS:Primary outcome parameters included overall survival and local recurrence rate. Secondary outcome parameters included 30 day mortality, sphincter preservation, pathological response of tumour, acute and late toxicity of treatment. The outcome parameters were summarized using the odds ratio and 95% confidence intervals (CI). MAIN RESULTS:There were 6 randomised controlled trials eligible for inclusion. A reduction in local recurrence was seen in the CRT group in comparison to the RT group (OR 0.56, 95% CI 0.42-0.75, P<0.0001). The results for overall survival were (OR=1.01 95%CI 0.85-1.20, P=0.88).The 30 day mortality was the same for both groups, CRT vs RT (OR 1.73, 95% CI 0.88-3.38). Sphincter preservation (stoma rate) was also similar for the two interventions (OR 1.02, 95% CI 0.85-1.21, P=0.64). An increase in acute grade 3/4 treatment related toxicity was seen in the CRT group versus the RT group (OR 3.96, 95% CI 3.03, 5.17, P<0.00001), although this result did display heterogeneity P=0.0005. Late toxicity events were similar between the two groups (OR 0.88, 95% CI 0.50, 1.54, P=0.65). AUTHORS' CONCLUSIONS:RT was compared to the more intensive CRT in the treatment of T3-4, node positive (locally advanced) rectal cancer. While there was no difference in overall survival between RT and CRT, CRT was associated with less local recurrence.
journal_name
Cochrane Database Syst Revjournal_title
The Cochrane database of systematic reviewsauthors
McCarthy K,Pearson K,Fulton R,Hewitt Jdoi
10.1002/14651858.CD008368.pub2subject
Has Abstractpub_date
2012-12-12 00:00:00pages
CD008368issn
1469-493Xjournal_volume
12pub_type
杂志文章,meta分析,评审abstract:BACKGROUND:Worldwide, phenytoin and phenobarbitone are commonly used antiepileptic drugs. They are more likely to be used in the developing world than the developed world, primarily because they are inexpensive. The aim of this review is to summarise data from existing trials comparing phenytoin and phenobarbitone. OB...
journal_title:The Cochrane database of systematic reviews
pub_type: 杂志文章,评审
doi:10.1002/14651858.CD002217
更新日期:2001-01-01 00:00:00
abstract:BACKGROUND:Sickle cell disease (SCD) is one of the commonest severe monogenic disorders in the world, due to the inheritance of two abnormal haemoglobin (beta globin) genes. SCD can cause severe pain, significant end-organ damage, pulmonary complications, and premature death. Silent cerebral infarcts are the commonest ...
journal_title:The Cochrane database of systematic reviews
pub_type: 杂志文章,meta分析,评审
doi:10.1002/14651858.CD012389.pub2
更新日期:2017-05-13 00:00:00
abstract:BACKGROUND:Chronic pain following mesh-based inguinal hernia repair is frequently reported, and has a significant impact on quality of life. Whether mesh fixation with glue can reduce chronic pain without increasing the recurrence rate is still controversial. OBJECTIVES:To determine whether tissue adhesives can reduce...
journal_title:The Cochrane database of systematic reviews
pub_type: 杂志文章,meta分析,评审
doi:10.1002/14651858.CD010814.pub2
更新日期:2017-02-07 00:00:00
abstract:BACKGROUND:Fractures of the shaft of the humerus account for 1% to 3% of all fractures in adults. The management of these fractures, including surgical intervention, varies widely. OBJECTIVES:To assess and compare the effects of surgical versus non-surgical intervention for non-pathological fractures of the humeral sh...
journal_title:The Cochrane database of systematic reviews
pub_type: 杂志文章,评审
doi:10.1002/14651858.CD008832.pub2
更新日期:2012-01-18 00:00:00
abstract:BACKGROUND:Couple therapy for depression has the twofold aim of modifying negative interaction patterns and increasing mutually supportive aspects of intimate relationships, changing the interpersonal context of depression. Couple therapy is included in several guidelines among the suggested treatments for depression. ...
journal_title:The Cochrane database of systematic reviews
pub_type: 杂志文章,meta分析,评审
doi:10.1002/14651858.CD004188.pub3
更新日期:2018-06-08 00:00:00
abstract:BACKGROUND:Patients with head and neck cancer are often malnourished. Surgery for such cancers is complex and may be undertaken after a course of radiotherapy. As a result, patients may have postoperative complications such as fistulae and wound infections, as well as more generalised infections such as pneumonia. One ...
journal_title:The Cochrane database of systematic reviews
pub_type: 杂志文章,meta分析
doi:10.1002/14651858.CD010954.pub2
更新日期:2018-08-30 00:00:00
abstract:BACKGROUND:Many women would like to avoid pharmacological or invasive methods of pain management in labour and this may contribute to the popularity of complementary methods of pain management. This review examined currently available evidence on the use of relaxation therapies for pain management in labour. This is an...
journal_title:The Cochrane database of systematic reviews
pub_type: 杂志文章,meta分析,评审
doi:10.1002/14651858.CD009514.pub2
更新日期:2018-03-28 00:00:00
abstract:BACKGROUND:Herpes simplex virus (HSV) is a rare but serious neonatal pathogen. Prior to the availability of antiviral drugs the mortality associated with all but localised neonatal infection was high, with 85% of infants with disseminated HSV infection and 50% of infants with encephalitis dying by one year of age. The ...
journal_title:The Cochrane database of systematic reviews
pub_type: 杂志文章,meta分析,评审
doi:10.1002/14651858.CD004206.pub2
更新日期:2009-07-08 00:00:00
abstract:BACKGROUND:Charcot-Marie-Tooth disease (CMT) comprises a large variety of different forms of motor and sensory neuropathies. The most frequent are demyelinating forms (CMT1) and axonal forms (CMT2). The molecular basis of several CMT forms has been clarified during the last 15 years. Since muscle wasting and sensory di...
journal_title:The Cochrane database of systematic reviews
pub_type: 杂志文章,评审
doi:10.1002/14651858.CD006052.pub2
更新日期:2008-01-23 00:00:00
abstract:BACKGROUND:An intraocular lens (IOL) is a synthetic lens that is surgically implanted within the eye following removal of the crystalline lens, during cataract surgery. While all modern IOLs attenuate the transmission of ultra-violet (UV) light, some IOLs, called blue-blocking or blue-light filtering IOLs, also reduce ...
journal_title:The Cochrane database of systematic reviews
pub_type: 杂志文章,meta分析,评审
doi:10.1002/14651858.CD011977.pub2
更新日期:2018-05-22 00:00:00
abstract:BACKGROUND:Cholecystectomy is not required in up to 64% of patients who adopt a wait-and-see policy after endoscopic clearance of common bile duct stones. Although reports of retrospective cohort series have shown a higher mortality among patients who defer cholecystectomy, it is not known if this is due to the patient...
journal_title:The Cochrane database of systematic reviews
pub_type: 杂志文章,meta分析,评审
doi:10.1002/14651858.CD006233.pub2
更新日期:2007-10-17 00:00:00
abstract:BACKGROUND:Absence seizures are brief epileptic seizures which present in childhood and adolescence. They are characterised by sudden loss of awareness and an electroencephalogram (EEG) typically shows generalised spike wave discharges at three cycles per second. Ethosuximide, valproate and lamotrigine are currently us...
journal_title:The Cochrane database of systematic reviews
pub_type: 杂志文章,评审
doi:10.1002/14651858.CD003032
更新日期:2003-01-01 00:00:00
abstract:BACKGROUND:In most western industrialised countries, second generation (atypical) antipsychotics are recommended as first line drug treatments for people with schizophrenia. In this review we specifically examine how the efficacy and tolerability of one such agent - aripiprazole - differs from that of other comparable ...
journal_title:The Cochrane database of systematic reviews
pub_type: 杂志文章,meta分析,评审
doi:10.1002/14651858.CD006569.pub4
更新日期:2013-02-28 00:00:00
abstract:BACKGROUND:Nasal polyps cause nasal obstruction, discharge and reduction in or loss of sense of smell, but their aetiology is unknown. The management of chronic rhinosinusitis with nasal polyps, aimed at improving these symptoms, includes both surgical and medical treatments, but there is no universally accepted manage...
journal_title:The Cochrane database of systematic reviews
pub_type: 杂志文章,meta分析,评审
doi:10.1002/14651858.CD006991.pub2
更新日期:2014-01-01 00:00:00
abstract:BACKGROUND:Intra-uterine insemination (IUI) is a widely used fertility treatment for couples with unexplained subfertility. Although IUI is less invasive and less expensive thAppendixan in vitro fertilisation (IVF), the safety of IUI in combination with ovarian hyperstimulation (OH) is debated. The main concern about I...
journal_title:The Cochrane database of systematic reviews
pub_type: 杂志文章,meta分析,评审
doi:10.1002/14651858.CD001838.pub5
更新日期:2016-02-19 00:00:00
abstract:BACKGROUND:Inspiratory muscle weakness has been observed in patients with stroke. Inspiratory muscle training is an intervention that has shown possible effects for functional recovery of patients with stroke. OBJECTIVES:To investigate the effect and safety of inspiratory muscle training for improving activities of da...
journal_title:The Cochrane database of systematic reviews
pub_type: 杂志文章,评审
doi:10.1002/14651858.CD009360.pub2
更新日期:2012-05-16 00:00:00
abstract:BACKGROUND:Carotid endarterectomy is conventionally undertaken by a longitudinal arteriotomy. Eversion carotid endarterectomy (CEA), which employs a transverse arteriotomy and reimplantation of the carotid artery, is reported to be associated with low perioperative stroke and restenosis rates but an increased risk of c...
journal_title:The Cochrane database of systematic reviews
pub_type: 杂志文章,评审
doi:10.1002/14651858.CD001921
更新日期:2001-01-01 00:00:00
abstract:BACKGROUND:Many people have asthma, and for some their symptoms may be triggered by psychological factors. In addition compliance with medical therapy may have a psychological dimension. Therefore, psychological interventions aim to reduce the burden of symptoms and improve management of the disease. OBJECTIVES:To ass...
journal_title:The Cochrane database of systematic reviews
pub_type: 杂志文章,评审
doi:10.1002/14651858.CD002982.pub2
更新日期:2004-01-01 00:00:00
abstract:BACKGROUND:The common cold is considered to be caused by viruses and it has long been believed that antibiotics have no role in treating this condition. In many countries doctors will often prescribe antibiotics for the common cold in the belief that they may prevent secondary bacterial infection and in some cases to r...
journal_title:The Cochrane database of systematic reviews
pub_type: 杂志文章,评审
doi:10.1002/14651858.CD000247
更新日期:2002-01-01 00:00:00
abstract:BACKGROUND:One way of attempting to improve fetal growth has been nutrient supplementation for the mother when fetal growth is impaired. Different nutrients such as carbohydrates and amino acids have been suggested as treatments for impaired fetal growth. OBJECTIVES:The objective of this review was to assess the effec...
journal_title:The Cochrane database of systematic reviews
pub_type: 杂志文章,评审
doi:10.1002/14651858.CD000148
更新日期:2003-01-01 00:00:00
abstract:BACKGROUND:The recommended management for neonates with a possible serious bacterial infection (PSBI) is hospitalisation and treatment with intravenous antibiotics, such as ampicillin plus gentamicin. However, hospitalisation is often not feasible for neonates in low- and middle-income countries (LMICs). Therefore, alt...
journal_title:The Cochrane database of systematic reviews
pub_type: 杂志文章,meta分析
doi:10.1002/14651858.CD007646.pub3
更新日期:2019-04-11 00:00:00
abstract:BACKGROUND:It is standard clinical practice to combine chemotherapy and chest radiotherapy in treating patients with limited-stage small cell lung cancer. However, the best way to integrate both modalities is unclear. OBJECTIVES:To establish the most effective way of combining chest radiotherapy with chemotherapy for ...
journal_title:The Cochrane database of systematic reviews
pub_type: 杂志文章,meta分析,评审
doi:10.1002/14651858.CD004700.pub2
更新日期:2005-01-25 00:00:00
abstract:BACKGROUND:Alzheimer's disease is the most common cause of dementia and is a primary degenerative disease of the brain of unknown cause. Onset is usually late in life with increasing impairment of memory, developing gradually into a global impairment of cognition, orientation, linguistic ability and judgement. The clin...
journal_title:The Cochrane database of systematic reviews
pub_type: 杂志文章,评审
doi:10.1002/14651858.CD001190
更新日期:2000-01-01 00:00:00
abstract:BACKGROUND:Postoperative pain remains a significant issue with poor perioperative pain management associated with an increased risk of morbidity and mortality. Liposomal bupivacaine is an analgesic consisting of bupivacaine hydrochloride encapsulated within multiple, non-concentric lipid bi-layers offering a novel meth...
journal_title:The Cochrane database of systematic reviews
pub_type: 杂志文章,meta分析,评审
doi:10.1002/14651858.CD011476.pub2
更新日期:2016-08-25 00:00:00
abstract:BACKGROUND:Guttate psoriasis is a distinctive acute form of psoriasis which characteristically occurs in children and young adults. Very little specific evidence-based guidance is available in standard texts to help make rational decisions about treatment options. OBJECTIVES:To assess the effectiveness of treatments f...
journal_title:The Cochrane database of systematic reviews
pub_type: 杂志文章,评审
doi:10.1002/14651858.CD001213.pub2
更新日期:2019-04-09 00:00:00
abstract:BACKGROUND:Premenstrual syndrome (PMS) is a common problem. Premenstrual dysphoric disorder (PMDD) is a severe form of premenstrual syndrome. Combined oral contraceptives, which provide both progestin and estrogen, have been examined for their ability to relieve premenstrual symptoms. An oral contraceptive containing d...
journal_title:The Cochrane database of systematic reviews
pub_type: 杂志文章,meta分析,评审
doi:10.1002/14651858.CD006586.pub4
更新日期:2012-02-15 00:00:00
abstract:BACKGROUND:Cranberries have been used widely for several decades for the prevention and treatment of urinary tract infections (UTIs). OBJECTIVES:To assess the effectiveness of cranberry products in preventing UTIs in susceptible populations. SEARCH STRATEGY:We searched MEDLINE, EMBASE, the Cochrane Central Register o...
journal_title:The Cochrane database of systematic reviews
pub_type: 杂志文章,meta分析,评审
doi:10.1002/14651858.CD001321.pub4
更新日期:2008-01-23 00:00:00
abstract:BACKGROUND:Gastro-oesophageal reflux (GOR) is an extremely common and usually self-limiting condition in infants. When treatment is required, Cisapride, a pro-kinetic agent, has been commonly prescribed for the symptomatic management of GOR. There have been recent reports of possibly serious adverse events, e.g. an inc...
journal_title:The Cochrane database of systematic reviews
pub_type: 杂志文章,评审
doi:10.1002/14651858.CD002300
更新日期:2003-01-01 00:00:00
abstract:BACKGROUND:An advance directive is a document specifying a person's preferences for treatment, should he or she lose capacity to make such decisions in the future. They have been used in end-of-life settings to direct care but should be well suited to the mental health setting. OBJECTIVES:To examine the effects of adv...
journal_title:The Cochrane database of systematic reviews
pub_type: 杂志文章,评审
doi:10.1002/14651858.CD005963.pub2
更新日期:2009-01-21 00:00:00
abstract:BACKGROUND:Recurrent respiratory papillomatosis is a condition characterised by benign papillomatous (wart-like) growths in the upper airway. It can affect both adults and children causing airway-obstruction and voice change. Treatment usually involves repeated surgical debulking of the papillomata, and several agents ...
journal_title:The Cochrane database of systematic reviews
pub_type: 杂志文章,评审
doi:10.1002/14651858.CD005053.pub2
更新日期:2005-10-19 00:00:00