Pre-operative chemoradiation for non-metastatic locally advanced rectal cancer.


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.


McCarthy K,Pearson K,Fulton R,Hewitt J




Has Abstract


2012-12-12 00:00:00








  • Intravenous or intramuscular parecoxib for acute postoperative pain in adults.

    abstract:BACKGROUND:Parecoxib was the first COX-2 available for parenteral administration, and may, given intravenously or intramuscularly, offer advantages over oral medication when patients have nausea and vomiting or are unable to swallow, such as in the immediate postoperative period. OBJECTIVES:Assess the efficacy of sing...

    journal_title:The Cochrane database of systematic reviews

    pub_type: 杂志文章,meta分析,评审


    authors: Lloyd R,Derry S,Moore RA,McQuay HJ

    更新日期:2009-04-15 00:00:00

  • Interventions for tubal ectopic pregnancy.

    abstract:BACKGROUND:The diagnosis of ectopic pregnancy can now often be made by non-invasive methods due to sensitive pregnancy tests (in urine and serum) and high resolution transvaginal sonography, which have been integrated in diagnostic algorithms. These algorithms, in combination with the increased awareness and knowledge ...

    journal_title:The Cochrane database of systematic reviews

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    authors: Hajenius PJ,Mol BW,Bossuyt PM,Ankum WM,Van Der Veen F

    更新日期:2000-01-01 00:00:00

  • Ergonomic and physiotherapeutic interventions for treating work-related complaints of the arm, neck or shoulder in adults.

    abstract:BACKGROUND:Conservative interventions such as physiotherapy and ergonomic adjustments (such as keyboard adjustments or ergonomic advice) play a major role in the treatment of most work-related complaints of the arm, neck or shoulder (CANS). OBJECTIVES:This systematic review aims to determine whether conservative inter...

    journal_title:The Cochrane database of systematic reviews

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    authors: Verhagen AP,Karels C,Bierma-Zeinstra SM,Burdorf L,Feleus A,Dahaghin S,de Vet HC,Koes BW

    更新日期:2006-07-19 00:00:00

  • Nitric oxide donors for cervical ripening in first-trimester surgical abortion.

    abstract:BACKGROUND:Cervical priming before first-trimester surgical abortion is recommended in certain groups of women. Nitric oxide (NO) donors induce cervical ripening without uterine contractions, but the efficacy and side effects are of concern. OBJECTIVES:To evaluate efficacy, side effects and complications of NO donors ...

    journal_title:The Cochrane database of systematic reviews

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    authors: Promsonthi P,Preechapornprasert D,Chanrachakul B

    更新日期:2009-10-07 00:00:00

  • Interventions for patients and caregivers to improve knowledge of sickle cell disease and recognition of its related complications.

    abstract:BACKGROUND:Sickle cell disease is a group of genetic diseases which is especially prevalent in tropical and subtropical regions; however, forced migration and ongoing population movement have spread it throughout the world, with estimated birth rates reaching 0.49 per 1000 in the Americas, 0.07 per 1000 in Europe, 0.68...

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    authors: Asnani MR,Quimby KR,Bennett NR,Francis DK

    更新日期:2016-10-06 00:00:00

  • Memantine for dementia.

    abstract:BACKGROUND:Memantine, a low affinity antagonist to glutamate NMDA receptors, may prevent excitatory neurotoxicity in dementia. OBJECTIVES:To determine efficacy and safety of memantine for people with Alzheimer's disease (AD), vascular (VD) and mixed dementia. SEARCH STRATEGY:The Specialized Register of the Cochrane D...

    journal_title:The Cochrane database of systematic reviews

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    authors: Areosa SA,Sherriff F,McShane R

    更新日期:2005-04-18 00:00:00

  • Prophylactic antibiotics to prevent surgical site infection after breast cancer surgery.

    abstract:BACKGROUND:Surgery has been used as part of breast cancer treatment for centuries; however any surgical procedure has the potential risk of infection. Infection rates for surgical treatment of breast cancer are documented at between 3% and 15%, higher than average for a clean surgical procedure. Pre- and perioperative ...

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    authors: Gallagher M,Jones DJ,Bell-Syer SV

    更新日期:2019-09-26 00:00:00

  • Bypass surgery for chronic lower limb ischaemia.

    abstract:BACKGROUND:Surgical bypass of an occluded arterial segment is the mainstay of treatment for patients with critical limb ischaemia. As with many surgical interventions, however, it was introduced without formal evaluation. OBJECTIVES:The objective of this review was to determine the effects of bypass surgery in patient...

    journal_title:The Cochrane database of systematic reviews

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    authors: Leng GC,Davis M,Baker D

    更新日期:2000-01-01 00:00:00

  • Extracorporeal membrane oxygenation for severe respiratory failure in newborn infants.

    abstract:BACKGROUND:Neonatal extracorporeal membrane oxygenation (ECMO) is a complex procedure of life support used in severe but potentially reversible respiratory failure in term infants. Although the number of babies eligible for ECMO is small and the use of ECMO invasive and potentially expensive, its benefits may be high. ...

    journal_title:The Cochrane database of systematic reviews

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    authors: Mugford M,Elbourne D,Field D

    更新日期:2008-07-16 00:00:00

  • Motivational interviewing for smoking cessation.

    abstract:BACKGROUND:Motivational Interviewing (MI) is a directive patient-centred style of counselling, designed to help people to explore and resolve ambivalence about behaviour change. It was developed as a treatment for alcohol abuse, but may help people to a make a successful attempt to quit smoking. OBJECTIVES:To determin...

    journal_title:The Cochrane database of systematic reviews

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    authors: Lindson-Hawley N,Thompson TP,Begh R

    更新日期:2015-03-02 00:00:00

  • Rectal 5-aminosalicylic acid for induction of remission in ulcerative colitis.

    abstract:BACKGROUND:5-Aminosalicylates (5-ASA) are considered a first-line therapy for inducing and maintaining remission of mild to moderately active ulcerative colitis (UC). When inflammation in UC is limited to the distal colon, 5-ASA can also be administered rectally as a suppository, enema or foam. OBJECTIVES:A systematic...

    journal_title:The Cochrane database of systematic reviews

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    authors: Marshall JK,Thabane M,Steinhart AH,Newman JR,Anand A,Irvine EJ

    更新日期:2010-01-20 00:00:00

  • Antibiotics for preventing respiratory tract infections in adults receiving intensive care.

    abstract:OBJECTIVES:Pneumonia is an important cause of mortality in intensive care units. The objective of this review was to assess the effects of antibiotics for preventing respiratory tract infections and overall mortality in adults receiving intensive care. SEARCH STRATEGY:We searched MEDLINE, proceedings of scientific mee...

    journal_title:The Cochrane database of systematic reviews

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    authors: Liberati A,D'Amico R,Pifferi S,Leonetti C,Torri V,Brazzi L,Tinazzi A

    更新日期:2000-01-01 00:00:00

  • Pulse oximetry screening for critical congenital heart defects.

    abstract:BACKGROUND:Health outcomes are improved when newborn babies with critical congenital heart defects (CCHDs) are detected before acute cardiovascular collapse. The main screening tests used to identify these babies include prenatal ultrasonography and postnatal clinical examination; however, even though both of these met...

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    authors: Plana MN,Zamora J,Suresh G,Fernandez-Pineda L,Thangaratinam S,Ewer AK

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  • Intraoperative mild hypothermia for postoperative neurological deficits in people with intracranial aneurysm.

    abstract:BACKGROUND:Rupture of an intracranial aneurysm causes aneurysmal subarachnoid haemorrhage, which is one of the most devastating clinical conditions. It can be classified into five Grades using the Hunt-Hess or World Federation of Neurological Surgeons (WFNS) scale. Grades 4 and 5 predict poor prognosis and are known as...

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    authors: Li LR,You C,Chaudhary B

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  • Interventions aimed at communities to inform and/or educate about early childhood vaccination.

    abstract:BACKGROUND:A range of strategies are used to communicate with parents, caregivers and communities regarding child vaccination in order to inform decisions and improve vaccination uptake. These strategies include interventions in which information is aimed at larger groups in the community, for instance at public meetin...

    journal_title:The Cochrane database of systematic reviews

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    authors: Saeterdal I,Lewin S,Austvoll-Dahlgren A,Glenton C,Munabi-Babigumira S

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  • Vitamin C and superoxide dismutase (SOD) for diabetic retinopathy.

    abstract:BACKGROUND:There is increasing evidence that diabetic retinopathy is caused by the action of free radicals. Radical scavengers like vitamin C and superoxide dismutase (SOD) may influence the outcome and progression of diabetic retinopathy, but no systematic review of the literature has been published to examine this hy...

    journal_title:The Cochrane database of systematic reviews

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    authors: Lopes de Jesus CC,Atallah AN,Valente O,Moça Trevisani VF

    更新日期:2008-01-23 00:00:00

  • Mediastinal chest drain clearance for cardiac surgery.

    abstract:BACKGROUND:Cardiac tamponade may occur following cardiac surgery as a result of blood or fluid collecting in the pericardial space compressing the heart and reducing cardiac output. Mediastinal chest drains (including pericardial drains) are inserted as standard post-operative practice following cardiac surgery to assi...

    journal_title:The Cochrane database of systematic reviews

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    authors: Wallen M,Morrison A,Gillies D,O'Riordan E,Bridge C,Stoddart F

    更新日期:2004-10-18 00:00:00

  • Physiotherapy for pain and disability in adults with complex regional pain syndrome (CRPS) types I and II.

    abstract:BACKGROUND:Complex regional pain syndrome (CRPS) is a painful and disabling condition that usually manifests in response to trauma or surgery. When it occurs, it is associated with significant pain and disability. It is thought to arise and persist as a consequence of a maladaptive pro-inflammatory response and disturb...

    journal_title:The Cochrane database of systematic reviews

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    authors: Smart KM,Wand BM,O'Connell NE

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  • Diclofenac with or without an antiemetic for acute migraine headaches in adults.

    abstract:BACKGROUND:This review is an update of a previously published review in Issue 2, 2012 (Derry 2012a). Migraine is a common, disabling condition and a burden for the individual, health services and society. Many sufferers choose not to, or are unable to, seek professional help and rely on over-the-counter (OTC) analgesic...

    journal_title:The Cochrane database of systematic reviews

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    authors: Derry S,Rabbie R,Moore RA

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  • Antibiotic prophylaxis for third- and fourth-degree perineal tear during vaginal birth.

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    authors: Buppasiri P,Lumbiganon P,Thinkhamrop J,Thinkhamrop B

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    journal_title:The Cochrane database of systematic reviews

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    authors: Gurusamy KS,Koti R,Davidson BR

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  • Optical coherence tomography for diagnosing skin cancer in adults.

    abstract:BACKGROUND:Early accurate detection of all skin cancer types is essential to guide appropriate management and to improve morbidity and survival. Melanoma and squamous cell carcinoma (SCC) are high-risk skin cancers, which have the potential to metastasise and ultimately lead to death, whereas basal cell carcinoma (BCC)...

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    authors: Ferrante di Ruffano L,Dinnes J,Deeks JJ,Chuchu N,Bayliss SE,Davenport C,Takwoingi Y,Godfrey K,O'Sullivan C,Matin RN,Tehrani H,Williams HC,Cochrane Skin Cancer Diagnostic Test Accuracy Group.

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    journal_title:The Cochrane database of systematic reviews

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    authors: Tharyan P,Adams CE

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  • Recombinant growth hormone therapy for cystic fibrosis in children and young adults.

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    authors: Tan BP,Hannah ME

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    authors: Cook LA,Van Vliet HA,Lopez LM,Pun A,Gallo MF

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    authors: Martí-Carvajal AJ,Anand V,Cardona AF,Solà I

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  • Subcutaneous rapid-acting insulin analogues for diabetic ketoacidosis.

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    journal_title:The Cochrane database of systematic reviews

    pub_type: 杂志文章,meta分析,评审


    authors: Andrade-Castellanos CA,Colunga-Lozano LE,Delgado-Figueroa N,Gonzalez-Padilla DA

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    journal_title:The Cochrane database of systematic reviews

    pub_type: 杂志文章,meta分析,评审


    authors: Juurlink DN,Buckley NA,Stanbrook MB,Isbister GK,Bennett M,McGuigan MA

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  • Chinese herbs combined with Western medicine for severe acute respiratory syndrome (SARS).

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    journal_title:The Cochrane database of systematic reviews

    pub_type: 杂志文章,meta分析,评审


    authors: Liu X,Zhang M,He L,Li Y

    更新日期:2012-10-17 00:00:00