The Role of Neoadjuvant Chemotherapy in Repeat Local Treatment of Recurrent Colorectal Liver Metastases: A Systematic Review and Meta-Analysis
The additive value of neoadjuvant chemotherapy (NAC) prior to repeat local treatment of patients with recurrent colorectal liver metastases (CRLM) is unclear. A systematic search was performed in PubMed, Embase, Web of Science, and an additional search in Google Scholar to find articles comparing re...
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MDPI AG
2021-01-01
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| Series: | Cancers |
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| Online Access: | https://www.mdpi.com/2072-6694/13/3/378 |
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| author | Madelon Dijkstra Sanne Nieuwenhuizen Robbert S. Puijk Bart Geboers Florentine E. F. Timmer Evelien A. C. Schouten Hester J. Scheffer Jan J. J. de Vries Johannes C. F. Ket Kathelijn S. Versteeg Martijn R. Meijerink M. Petrousjka van den Tol |
| author_facet | Madelon Dijkstra Sanne Nieuwenhuizen Robbert S. Puijk Bart Geboers Florentine E. F. Timmer Evelien A. C. Schouten Hester J. Scheffer Jan J. J. de Vries Johannes C. F. Ket Kathelijn S. Versteeg Martijn R. Meijerink M. Petrousjka van den Tol |
| author_sort | Madelon Dijkstra |
| collection | DOAJ |
| description | The additive value of neoadjuvant chemotherapy (NAC) prior to repeat local treatment of patients with recurrent colorectal liver metastases (CRLM) is unclear. A systematic search was performed in PubMed, Embase, Web of Science, and an additional search in Google Scholar to find articles comparing repeat local treatment by partial hepatectomy and/or thermal ablation with versus without NAC. The search included randomized trials and comparative observational studies with univariate/multivariate analysis and/or matching as well as (inter)national guidelines assessed using the AGREE II instrument. The search identified 21,832 records; 172 were selected for full-text review; 20 were included: 20 comparative observational studies were evaluated. Literature to evaluate the additive value of NAC prior to repeat local treatment was limited. Outcomes of NAC were often reported as subgroup analyses and reporting of results was frequently unclear. Assessment of the seven studies that qualified for inclusion in the meta-analysis showed conflicting results. Only one study reported a significant difference in overall survival (OS) favoring NAC prior to repeat local treatment. However, further analysis revealed a high risk for residual bias, because only a selected group of chemo-responders qualified for repeat local treatment, disregarding the non-responders who did not qualify. All guidelines that specifically mention recurrent disease (3/3) recommend repeat local treatment; none provide recommendations about the role of NAC. The inconclusive findings of this meta-analysis do not support recommendations to routinely favor NAC prior to repeat local treatment. This emphasizes the need to investigate the additive value of NAC prior to repeat local treatment of patients with recurrent CRLM in a future phase 3 randomized controlled trial (RCT). |
| first_indexed | 2024-03-09T04:10:21Z |
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| institution | Directory Open Access Journal |
| issn | 2072-6694 |
| language | English |
| last_indexed | 2024-03-09T04:10:21Z |
| publishDate | 2021-01-01 |
| publisher | MDPI AG |
| record_format | Article |
| series | Cancers |
| spelling | doaj.art-1ab18536d65b4d53bfa1e50a1a17d4982023-12-03T14:00:20ZengMDPI AGCancers2072-66942021-01-0113337810.3390/cancers13030378The Role of Neoadjuvant Chemotherapy in Repeat Local Treatment of Recurrent Colorectal Liver Metastases: A Systematic Review and Meta-AnalysisMadelon Dijkstra0Sanne Nieuwenhuizen1Robbert S. Puijk2Bart Geboers3Florentine E. F. Timmer4Evelien A. C. Schouten5Hester J. Scheffer6Jan J. J. de Vries7Johannes C. F. Ket8Kathelijn S. Versteeg9Martijn R. Meijerink10M. Petrousjka van den Tol11Department of Radiology and Nuclear Medicine, Amsterdam University Medical Center, VU Medical Center Amsterdam, 1081 HV Amsterdam, The NetherlandsDepartment of Radiology and Nuclear Medicine, Amsterdam University Medical Center, VU Medical Center Amsterdam, 1081 HV Amsterdam, The NetherlandsDepartment of Radiology and Nuclear Medicine, Amsterdam University Medical Center, VU Medical Center Amsterdam, 1081 HV Amsterdam, The NetherlandsDepartment of Radiology and Nuclear Medicine, Amsterdam University Medical Center, VU Medical Center Amsterdam, 1081 HV Amsterdam, The NetherlandsDepartment of Radiology and Nuclear Medicine, Amsterdam University Medical Center, VU Medical Center Amsterdam, 1081 HV Amsterdam, The NetherlandsDepartment of Radiology and Nuclear Medicine, Amsterdam University Medical Center, VU Medical Center Amsterdam, 1081 HV Amsterdam, The NetherlandsDepartment of Radiology and Nuclear Medicine, Amsterdam University Medical Center, VU Medical Center Amsterdam, 1081 HV Amsterdam, The NetherlandsDepartment of Radiology and Nuclear Medicine, Amsterdam University Medical Center, VU Medical Center Amsterdam, 1081 HV Amsterdam, The NetherlandsMedical Library, Vrije Universiteit Amsterdam, 1081 HV Amsterdam, The NetherlandsDepartment of Medical Oncology, Amsterdam University Medical Center, VU Medical Center Amsterdam Cancer Center Amsterdam, 1081 HV Amsterdam, The NetherlandsDepartment of Radiology and Nuclear Medicine, Amsterdam University Medical Center, VU Medical Center Amsterdam, 1081 HV Amsterdam, The NetherlandsDepartment of Surgery, Amsterdam University Medical Center, location VU Medical Center Amsterdam, 1081 HV Amsterdam, The NetherlandsThe additive value of neoadjuvant chemotherapy (NAC) prior to repeat local treatment of patients with recurrent colorectal liver metastases (CRLM) is unclear. A systematic search was performed in PubMed, Embase, Web of Science, and an additional search in Google Scholar to find articles comparing repeat local treatment by partial hepatectomy and/or thermal ablation with versus without NAC. The search included randomized trials and comparative observational studies with univariate/multivariate analysis and/or matching as well as (inter)national guidelines assessed using the AGREE II instrument. The search identified 21,832 records; 172 were selected for full-text review; 20 were included: 20 comparative observational studies were evaluated. Literature to evaluate the additive value of NAC prior to repeat local treatment was limited. Outcomes of NAC were often reported as subgroup analyses and reporting of results was frequently unclear. Assessment of the seven studies that qualified for inclusion in the meta-analysis showed conflicting results. Only one study reported a significant difference in overall survival (OS) favoring NAC prior to repeat local treatment. However, further analysis revealed a high risk for residual bias, because only a selected group of chemo-responders qualified for repeat local treatment, disregarding the non-responders who did not qualify. All guidelines that specifically mention recurrent disease (3/3) recommend repeat local treatment; none provide recommendations about the role of NAC. The inconclusive findings of this meta-analysis do not support recommendations to routinely favor NAC prior to repeat local treatment. This emphasizes the need to investigate the additive value of NAC prior to repeat local treatment of patients with recurrent CRLM in a future phase 3 randomized controlled trial (RCT).https://www.mdpi.com/2072-6694/13/3/378repeat local treatmentthermal ablationpartial hepatectomy(neoadjuvant) chemotherapyrecurrent colorectal liver metastases (CRLM) |
| spellingShingle | Madelon Dijkstra Sanne Nieuwenhuizen Robbert S. Puijk Bart Geboers Florentine E. F. Timmer Evelien A. C. Schouten Hester J. Scheffer Jan J. J. de Vries Johannes C. F. Ket Kathelijn S. Versteeg Martijn R. Meijerink M. Petrousjka van den Tol The Role of Neoadjuvant Chemotherapy in Repeat Local Treatment of Recurrent Colorectal Liver Metastases: A Systematic Review and Meta-Analysis Cancers repeat local treatment thermal ablation partial hepatectomy (neoadjuvant) chemotherapy recurrent colorectal liver metastases (CRLM) |
| title | The Role of Neoadjuvant Chemotherapy in Repeat Local Treatment of Recurrent Colorectal Liver Metastases: A Systematic Review and Meta-Analysis |
| title_full | The Role of Neoadjuvant Chemotherapy in Repeat Local Treatment of Recurrent Colorectal Liver Metastases: A Systematic Review and Meta-Analysis |
| title_fullStr | The Role of Neoadjuvant Chemotherapy in Repeat Local Treatment of Recurrent Colorectal Liver Metastases: A Systematic Review and Meta-Analysis |
| title_full_unstemmed | The Role of Neoadjuvant Chemotherapy in Repeat Local Treatment of Recurrent Colorectal Liver Metastases: A Systematic Review and Meta-Analysis |
| title_short | The Role of Neoadjuvant Chemotherapy in Repeat Local Treatment of Recurrent Colorectal Liver Metastases: A Systematic Review and Meta-Analysis |
| title_sort | role of neoadjuvant chemotherapy in repeat local treatment of recurrent colorectal liver metastases a systematic review and meta analysis |
| topic | repeat local treatment thermal ablation partial hepatectomy (neoadjuvant) chemotherapy recurrent colorectal liver metastases (CRLM) |
| url | https://www.mdpi.com/2072-6694/13/3/378 |
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