Efficacy and Safety of Hyperthermo-Chemo-Radiotherapy for Rectal Cancer: A Systematic Review_Chinese Journal of Evidence-Based Medicine

Authors：

 LIZheng ^1,2,3 ,  MIDeng-hai ^1,2,3 , YANGKe-hu ^1,2 , CAONong ¹ , TIANJin-hui ² , MABin ² , BAIZheng-gang ²

1. The First Clinical Medical College of Lanzhou University, Lanzhou 730000, China;
2. Evidence Based Medicine Center of Lanzhou University, Lanzhou 730000, China;
3. The Second People's Hospital of Gansu Province, Lanzhou 730000, China;

Corresponding author：

MIDeng-hai, Email: mi.dh@163.com

Keywords：

Rectal cancer; Hyperthermia; Chemotherapy; Radiotherapy; Systematic review; Meta-Analysis; Randomized controlled trial

DOI：

10.7507/1672-2531.20150114

Video：

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Objective To systematically review the efficacy and safety of chemo-radiotherapy combined with hyperthermia (HCRT) for rectal cancer, and to provide evidence for clinical practice. Methods We searched the Cochrane Library (Issue 6, 2014), PubMed, EMbase, Web of Science, CBM, CNKI, VIP and WanFang Data databases from inception to July 2014. All relevant randomized controlled trials (RCTs) of HCRT for rectal cancer were collected. Two reviewers independently screened literature, extracted data, and assessed the risk of bias of included studies. Then meta-analysis was performed using RevMan 5.3 software. Results A total of 9 RCTs involving 663 patients were included. The results of meta-analysis showed that:Compared with the chemo-radiotherapy (CRT) group, the HCRT group were significant superior in complete response (OR=3.74, 95%CI 2.14 to 6.53), total effective rate (OR=4.23, 95%CI 2.69 to 6.66), 3-year survival rate (OR=4.48, 95%CI 1.81 to 11.06) and recurrence rate (OR=0.19, 95%CI 0.09 to 0.42). ②Compared with the radiotherapy (RT) group, the HCRT group was associated with significant improvement in complete response rate (OR=3.01, 95%CI 1.24 to 7.29). Conclusion Current evidence shows, HCRT is superior to CRT or RT in the treatment of rectal cancer. However, due to the limited quantity and quality of the included studies, more high quality studies are needed to verify the above conclusion.

Citation： LIZheng, MIDeng-hai, YANGKe-hu, CAONong, TIANJin-hui, MABin, BAIZheng-gang. Efficacy and Safety of Hyperthermo-Chemo-Radiotherapy for Rectal Cancer: A Systematic Review. Chinese Journal of Evidence-Based Medicine, 2015, 15(6): 687-692. doi: 10.7507/1672-2531.20150114 Copy

1.	Torre LA,Bray F,Siegel RL,et al.Global cancer statistics,2012.CA Cancer J Clin,2015,65(2):87-108.
2.	周总光,杨烈,李园,等.我国结直肠癌30年变迁与应对策略.中国实用外科杂志,2012,32(9):693-696.
3.	Wust P,Hildebrandt B,Sreenivasa G,et al.Hyperthermia in combined treatment of cancer.Lancet Oncol,2002,3(8):487-497.
4.	Hildebrandt B,Rau B,Loffel J,et al.Adjuvant chemotherapy with folinic acid and 5-fluorouracil in patients with locally advanced rectal cancer previously treated by preoperative radiochemotherapy and curative tumor resection.Int J Colorectal Dis,2006,21(6):582-589.
5.	Furuta K,Konishi F,Kanazawa K,et al.Synergistic effects of hyperthermia in preoperative radiochemotherapy for rectal carcinoma.Dis Colon Rectum,1997,40(11):1303-1312.
6.	Kang MK,Kim MS,Kim JH.Clinical outcomes of mild hyperthermia for locally advanced rectal cancer treated with preoperative radiochemotherapy.Int J Hyperthermia,2011,27(5):482-490.
7.	米登海,李征,杨克虎,等.热放化三联疗法治疗非小细胞肺癌的Meta分析.中国循证医学杂志,2011,11(11):1262-1267.
8.	米登海,李征,杨克虎,等.热化放三联疗法治疗食管癌的Meta分析.实用肿瘤杂志,2013,28(1):28-35.
9.	Guyatt GH,Oxman AD,Kunz R,et al.GRADE guidelines:8.Rating the quality of evidence--indirectness.J Clin Epidemiol,2011,64(12):1303-1310.
10.	Higgins JPT,Green S.Cochrane Handbook for Systematic Reviews of Interventions Version 5.1.0[updated March 2011].The Cochrane Collaboration,2011.Available at:www.cochrane.org/training/cochrane-handbook.
11.	喻志冲,袁洪香,王贺芳.局部晚期直肠癌综合治疗疗效分析.中国临床医学,2003,10(6):851,853.
12.	Kouloulias V,Plataniotis G,Kouvaris J,et al.Chemoradiotherapy combined with intracavitary hyperthermia for anal cancer:feasibility and long-term results from a phase II randomized trial.Am J Clin Oncol,2005,28(1):91-99.
13.	赵军,王宝中,盛延兴,等.放化疗结合相控阵聚焦热疗治疗直肠癌术后局部区域复发的临床观察.中华肿瘤防治杂志,2009,16(21):1691-1693.
14.	代素梅,卢玉娟,刘洪敏,等.三维适形放射治疗同步化疗联合热疗对局部晚期及术后局部复发直肠癌近期疗效的研究.现代预防医学,2011,38(10):1996-1997,1999.
15.	沈雄虎,金永民,张松男,等.术前放疗、化疗联合热疗治疗直肠癌局部复发的临床分析.现代预防医学,2011,38(19):4023-4024.
16.	Schroeder C,Gani C,Lamprecht U,et al.Pathological complete response and sphincter-sparing surgery after neoadjuvant radiochemotherapy with regional hyperthermia for locally advanced rectal cancer compared with radiochemotherapy alone.Int J Hyperthermia,2012,28(8):707-714.
17.	胡金飞,王道荣.新辅助放化疗联合热疗治疗进展期直肠癌的临床效果和安全性.中国医药导报,2013,10(30):64-66,70.
18.	温本,郑文滔,颜劲,等.新辅助放化疗热疗联合腹腔镜手术治疗进展期直肠癌的临床疗效.中国肿瘤临床与康复,2013,20(11):1270-1272.
19.	邓微.进展期直肠癌新辅助放化疗加热疗的疗效分析.中国保健营养(中旬刊),2014,4(24):2549.
20.	詹宏杰,梁寒.肿瘤热疗的研究.国外医学(肿瘤学分册),2005,32(1):35-38.
21.	Falk MH,Issels RD.Hyperthermia in oncology.Int J Hyperthermia,2001,17(1):1-18.
22.	vander Zee J.Heating the patient:a promising approach? Ann Oncol,2002,13(8):1173-1184.
23.	de Haas-Kock DF,Buijsen J,Pijls-Johannesma M,et al.Concomitant hyperthermia and radiation therapy for treating locally advanced rectal cancer.Cochrane Database Syst Rev,2009,(3):CD006269.
24.	颉宝平,李征,姚南,等.化疗联合热疗治疗晚期大肠癌疗效及安全性的Meta分析.中国循证医学杂志,2013,13(3):352-357.
25.	张娜,朱远.肿瘤热放疗、化疗在直肠癌治疗中的研究进展.实用肿瘤杂志,2008,23(6):586-590.
26.	Rau B,Wust P,Tilly W,et al.Preoperative radiochemotherapy in locally advanced or recurrent rectal cancer:regional radiofrequency hyperthermia correlates with clinical parameters.Int J Radiat Oncol Biol Phys,2000,48(2):381-391.
27.	Ichikawa D,Yamaguchi T,Yoshioka Y,et al.Prognostic evaluation of preoperative combined treatment for advanced cancer in the lower rectum with radiation,intraluminal hyperthermia,and 5-fluorouracil suppository.Am J Surg,1996,171(3):346-350.
28.	Wust P,Rau B,Gellerman J,et al.Radiochemotherapy and hyperthermia in the treatment of rectal cancer.Recent Results Cancer Res,1998,146:175-191.
29.	Asao T,Sakurai H,Harashima K,et al.The synchronization of chemotherapy to circadian rhythms and irradiation in pre-operative chemoradiation therapy with hyperthermia for local advanced rectal cancer.Int J Hyperthermia,2006,22(5):399-406.
30.	Milani V,Pazos M,Issels RD,et al.Radiochemotherapy in combination with regional hyperthermia in preirradiated patients with recurrent rectal cancer.Strahlenther Onkol,2008,184(3):163-168.
31.	Schulze T,Wust P,Gellermann J,et al.Influence of neoadjuvant radiochemotherapy combined with hyperthermia on the quality of life in rectum cancer patients.Int J Hyperthermia,2006,22(4):301-318.
32.	Bruggmoser G,Bauchowitz S,Canters R,et al.Quality assurance for clinical studies in regional deep hyperthermia.Strahlenther Onkol,2011,187(10):605-610.

1. Torre LA,Bray F,Siegel RL,et al.Global cancer statistics,2012.CA Cancer J Clin,2015,65(2):87-108.
2. 周总光,杨烈,李园,等.我国结直肠癌30年变迁与应对策略.中国实用外科杂志,2012,32(9):693-696.
3. Wust P,Hildebrandt B,Sreenivasa G,et al.Hyperthermia in combined treatment of cancer.Lancet Oncol,2002,3(8):487-497.
4. Hildebrandt B,Rau B,Loffel J,et al.Adjuvant chemotherapy with folinic acid and 5-fluorouracil in patients with locally advanced rectal cancer previously treated by preoperative radiochemotherapy and curative tumor resection.Int J Colorectal Dis,2006,21(6):582-589.
5. Furuta K,Konishi F,Kanazawa K,et al.Synergistic effects of hyperthermia in preoperative radiochemotherapy for rectal carcinoma.Dis Colon Rectum,1997,40(11):1303-1312.
6. Kang MK,Kim MS,Kim JH.Clinical outcomes of mild hyperthermia for locally advanced rectal cancer treated with preoperative radiochemotherapy.Int J Hyperthermia,2011,27(5):482-490.
7. 米登海,李征,杨克虎,等.热放化三联疗法治疗非小细胞肺癌的Meta分析.中国循证医学杂志,2011,11(11):1262-1267.
8. 米登海,李征,杨克虎,等.热化放三联疗法治疗食管癌的Meta分析.实用肿瘤杂志,2013,28(1):28-35.
9. Guyatt GH,Oxman AD,Kunz R,et al.GRADE guidelines:8.Rating the quality of evidence--indirectness.J Clin Epidemiol,2011,64(12):1303-1310.
10. Higgins JPT,Green S.Cochrane Handbook for Systematic Reviews of Interventions Version 5.1.0[updated March 2011].The Cochrane Collaboration,2011.Available at:www.cochrane.org/training/cochrane-handbook.
11. 喻志冲,袁洪香,王贺芳.局部晚期直肠癌综合治疗疗效分析.中国临床医学,2003,10(6):851,853.
12. Kouloulias V,Plataniotis G,Kouvaris J,et al.Chemoradiotherapy combined with intracavitary hyperthermia for anal cancer:feasibility and long-term results from a phase II randomized trial.Am J Clin Oncol,2005,28(1):91-99.
13. 赵军,王宝中,盛延兴,等.放化疗结合相控阵聚焦热疗治疗直肠癌术后局部区域复发的临床观察.中华肿瘤防治杂志,2009,16(21):1691-1693.
14. 代素梅,卢玉娟,刘洪敏,等.三维适形放射治疗同步化疗联合热疗对局部晚期及术后局部复发直肠癌近期疗效的研究.现代预防医学,2011,38(10):1996-1997,1999.
15. 沈雄虎,金永民,张松男,等.术前放疗、化疗联合热疗治疗直肠癌局部复发的临床分析.现代预防医学,2011,38(19):4023-4024.
16. Schroeder C,Gani C,Lamprecht U,et al.Pathological complete response and sphincter-sparing surgery after neoadjuvant radiochemotherapy with regional hyperthermia for locally advanced rectal cancer compared with radiochemotherapy alone.Int J Hyperthermia,2012,28(8):707-714.
17. 胡金飞,王道荣.新辅助放化疗联合热疗治疗进展期直肠癌的临床效果和安全性.中国医药导报,2013,10(30):64-66,70.
18. 温本,郑文滔,颜劲,等.新辅助放化疗热疗联合腹腔镜手术治疗进展期直肠癌的临床疗效.中国肿瘤临床与康复,2013,20(11):1270-1272.
19. 邓微.进展期直肠癌新辅助放化疗加热疗的疗效分析.中国保健营养(中旬刊),2014,4(24):2549.
20. 詹宏杰,梁寒.肿瘤热疗的研究.国外医学(肿瘤学分册),2005,32(1):35-38.
21. Falk MH,Issels RD.Hyperthermia in oncology.Int J Hyperthermia,2001,17(1):1-18.
22. vander Zee J.Heating the patient:a promising approach? Ann Oncol,2002,13(8):1173-1184.
23. de Haas-Kock DF,Buijsen J,Pijls-Johannesma M,et al.Concomitant hyperthermia and radiation therapy for treating locally advanced rectal cancer.Cochrane Database Syst Rev,2009,(3):CD006269.
24. 颉宝平,李征,姚南,等.化疗联合热疗治疗晚期大肠癌疗效及安全性的Meta分析.中国循证医学杂志,2013,13(3):352-357.
25. 张娜,朱远.肿瘤热放疗、化疗在直肠癌治疗中的研究进展.实用肿瘤杂志,2008,23(6):586-590.
26. Rau B,Wust P,Tilly W,et al.Preoperative radiochemotherapy in locally advanced or recurrent rectal cancer:regional radiofrequency hyperthermia correlates with clinical parameters.Int J Radiat Oncol Biol Phys,2000,48(2):381-391.
27. Ichikawa D,Yamaguchi T,Yoshioka Y,et al.Prognostic evaluation of preoperative combined treatment for advanced cancer in the lower rectum with radiation,intraluminal hyperthermia,and 5-fluorouracil suppository.Am J Surg,1996,171(3):346-350.
28. Wust P,Rau B,Gellerman J,et al.Radiochemotherapy and hyperthermia in the treatment of rectal cancer.Recent Results Cancer Res,1998,146:175-191.
29. Asao T,Sakurai H,Harashima K,et al.The synchronization of chemotherapy to circadian rhythms and irradiation in pre-operative chemoradiation therapy with hyperthermia for local advanced rectal cancer.Int J Hyperthermia,2006,22(5):399-406.
30. Milani V,Pazos M,Issels RD,et al.Radiochemotherapy in combination with regional hyperthermia in preirradiated patients with recurrent rectal cancer.Strahlenther Onkol,2008,184(3):163-168.
31. Schulze T,Wust P,Gellermann J,et al.Influence of neoadjuvant radiochemotherapy combined with hyperthermia on the quality of life in rectum cancer patients.Int J Hyperthermia,2006,22(4):301-318.
32. Bruggmoser G,Bauchowitz S,Canters R,et al.Quality assurance for clinical studies in regional deep hyperthermia.Strahlenther Onkol,2011,187(10):605-610.

Chinese Journal of Evidence-Based Medicine

Efficacy and Safety of Hyperthermo-Chemo-Radiotherapy for Rectal Cancer: A Systematic Review

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