Preoperative Short-Course Radiotherapy and Surgery versus Surgery Alone for Patients with Rectal Cancer: A Propensity Score-Matched Analysis at 18-Year Follow-Up

Abstract

A significant problem for long-term rectal cancer survivors may be the late toxicity of radiotherapy. It creates the possible risk of developing second primary malignancy and a theoretical decrease in overall survival. This study aimed to assess the influence of short-course preoperative radiotherapy in patients with locally advanced rectal cancer on overall survival, local recurrence rate, and second malignancy at 18-year follow-up. The rectal cancer trial was conducted in a single tertiary center between February 1992 and June 2006. A total of 389 patients with locally advanced rectal cancer (cT2-cT4, cN0/+, cM0) were included in the study. Preoperative radiotherapy was conducted in 148 patients and 241 patients underwent surgery alone. The propensity-matched group consisted of 105 patients operated on after radiotherapy and 105 controls. The number of local recurrences was 7 (6.7%) in the preoperative radiotherapy group and 22 (21%) in the surgery alone group (p = 0.016). The 18-year survival analysis showed no survival benefit in the preoperative radiotherapy group (38% versus 48%, p = 0.107) but improved recurrence-free survival (81% versus 58%, p = 0.001). The preoperative short-course radiotherapy significantly decreases the risk of local recurrence in locally advanced rectal cancer and may improve recurrence-free survival without an increased risk of second primary malignancy.

Global status of research on radiotherapy for rectal cancer: A bibliometric and visual analysis

“…Whether preoperative radiotherapy can increase patient survival remains controversial. Early studies have shown survival benefit of preoperative radiotherapy ( 31 , 52 ), but recent studies do not support this conclusion ( 19 , 23 , 53 , 54 ). Notably, it has become a consensus that preoperative radiotherapy can reduce the local recurrence rate and improve the surgical resection rate, tumor local control rate and sphincter preservation rate of rectal cancer ( 14 , 55 , 56 ).…”

Quality of life and clinical outcomes in rectal cancer patients treated on a 1.5T MR-Linac within the MOMENTUM study

“…SCRT is commonly used in the neoadjuvant setting for selected patients with rectal cancer, mainly for those with intermediate risk disease. Studies have demonstrated the benefit of SCRT for the reduction of local recurrence rates and improving long-term outcomes as compared to surgery alone [26] , [27] . Other studies showed that SCRT results in tumor downstaging and in some cases even in a clinical or pathological complete response after delayed surgery [9] , [12] , [28] , [29] .…”