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Purpose <p>The individual chemotherapy- and radiotherapy-related toxicities between induction (iTNT) and consolidation total neoadjuvant therapy (cTNT) remain unclear. This network meta-analysis (NMA) comparing iTNT, cTNT, and traditional neoadjuvant chemoradiation (nCRT) evaluated the comparative treatment-related toxicities and compliance of the TNT schemas.</p> Methods <p>A systematic review of randomized clinical trials and nonrandomized studies of interventions was performed as per Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA)-NMA guidelines. A Bayesian NMA was conducted, and odds ratios (OR) with 95% credible intervals (CrI) are reported for all outcomes.</p> Results <p>Eighteen studies including 5730 patients were identified. iTNT ranked highest on rate of rectal bleeding (cTNT: OR 0.23 95% CrI 0.05–0.93; nCRT: OR 0.33, 95% CrI 0.09–0.96), proctitis (cTNT: OR 0.2, 95% CrI 0.06–0.55; nCRT: OR 0.2, 95% CrI 0.06–0.51), and postoperative diarrhea (cTNT: OR 0.37, 95% CrI 0.18–0.73; nCRT: OR 0.33, 95% CrI 0.15–0.71); cTNT ranked highest on rate of vomiting (iTNT: OR 0.24, 95% CrI 0.05–0.96; nCRT: OR 0.29, 95% CrI 0.06–0.89) and a higher rate of lymphopenia than iTNT (iTNT: OR 0.56, 95% CrI 0.34–0.99). Radiotherapy compliance was highest in cTNT (iTNT: OR 0.23, 95% CrI 0.05–0.72; nCRT: OR 0.18, 95% CrI 0.04–0.58). There was no difference in overall toxicity and mortality, chemotherapy compliance, and remaining individual system-based toxicities and postoperative complications.</p> Conclusions <p>Across all treatment strategies, iTNT had higher radiation-related gastrointestinal toxicities and postoperative diarrhea; cTNT had higher vomiting and lymphopenia rates. While no treatment strategy was superior in chemotherapy compliance, radiotherapy compliance was ranked highest in cTNT.</p>

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Compliance and Toxicity of Total Neoadjuvant Therapy in Locally Advanced Rectal Cancer: A Systematic Review and Network Meta-analysis

  • 期刊论文

  • 出版模式：

    开放获取

  • 发表日期：

    2025年5月5日

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  • Warren Seow,
  • Ishraq Murshed,
  • Zachary Bunjo,
  • Sergei Bedrikovetski,
  • Jennifer Stone,
  • Tarik Sammour

摘要

Purpose

The individual chemotherapy- and radiotherapy-related toxicities between induction (iTNT) and consolidation total neoadjuvant therapy (cTNT) remain unclear. This network meta-analysis (NMA) comparing iTNT, cTNT, and traditional neoadjuvant chemoradiation (nCRT) evaluated the comparative treatment-related toxicities and compliance of the TNT schemas.

Methods

A systematic review of randomized clinical trials and nonrandomized studies of interventions was performed as per Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA)-NMA guidelines. A Bayesian NMA was conducted, and odds ratios (OR) with 95% credible intervals (CrI) are reported for all outcomes.

Results

Eighteen studies including 5730 patients were identified. iTNT ranked highest on rate of rectal bleeding (cTNT: OR 0.23 95% CrI 0.05–0.93; nCRT: OR 0.33, 95% CrI 0.09–0.96), proctitis (cTNT: OR 0.2, 95% CrI 0.06–0.55; nCRT: OR 0.2, 95% CrI 0.06–0.51), and postoperative diarrhea (cTNT: OR 0.37, 95% CrI 0.18–0.73; nCRT: OR 0.33, 95% CrI 0.15–0.71); cTNT ranked highest on rate of vomiting (iTNT: OR 0.24, 95% CrI 0.05–0.96; nCRT: OR 0.29, 95% CrI 0.06–0.89) and a higher rate of lymphopenia than iTNT (iTNT: OR 0.56, 95% CrI 0.34–0.99). Radiotherapy compliance was highest in cTNT (iTNT: OR 0.23, 95% CrI 0.05–0.72; nCRT: OR 0.18, 95% CrI 0.04–0.58). There was no difference in overall toxicity and mortality, chemotherapy compliance, and remaining individual system-based toxicities and postoperative complications.

Conclusions

Across all treatment strategies, iTNT had higher radiation-related gastrointestinal toxicities and postoperative diarrhea; cTNT had higher vomiting and lymphopenia rates. While no treatment strategy was superior in chemotherapy compliance, radiotherapy compliance was ranked highest in cTNT.