Short course radiotherapy and delayed surgery for locally advanced rectal cancer in frail patients: is it a valid option?

Lancellotti, Francesco; Solinas, Luigi; Sagnotta, Andrea; Mancini, Stefano; Cosentino, L.; Belardi, A; Battaglia, Benedetto; Mirri, M.A.; Ciabattoni, Antonella; Salerno, Francesca; Loponte, Margherita

doi:10.1016/j.ejso.2021.03.230

Cited by 2 publications

(1 citation statement)

References 50 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…7 However, SCRT has not been considered as effective as LCRT worldwide. 8 Considering the high risk of occult metastasis for LARC, employment of preoperative systemic chemotherapy would improve the likelihood of eradicating aggressive tumor biology and also increase the benefit from surgery. [6][7][8] Given this information, consolidation chemotherapy strategies would improve the complete response, decrease the distant metastasis rate, and increase the compliance rate to chemotherapy.…”

Section: Conclusionesmentioning

confidence: 99%

Short-Course Radiotherapy Followed By Consolidation Chemotherapy Is Safe and Effective In Locally Advanced Rectal Cancer: Comparative Short-term Results of Multicenter Propensity Score Case-Matched Study

Benlice

Koç

Gulcu

et al. 2023

Diseases of the Colon &Amp; Rectum

View full text Add to dashboard Cite

BACKGROUND: Consolidation chemotherapy strategies have demonstrated improved pathological complete response and tumor downstaging rates for patients diagnosed with rectal cancer. OBJECTIVE: This study aimed to compare perioperative outcomes and pathological complete response rates among different neoadjuvant treatment strategies in patients undergoing total mesorectal excision for locally advanced rectal cancer. DESIGN: Propensity score case-matched study. SETTING: High-volume tertiary care centers. PATIENTS: Consecutive patients undergoing curative total mesorectal excision between January 2014 and June 2021 were queried. INTERVENTIONS: Patients were divided into 3 groups: long-course chemoradiation therapy with (N = 128) or without (N = 164) consolidation chemotherapy or short-course radiotherapy (N = 53) followed by consolidation chemotherapy. MAIN OUTCOME MEASURES: Demographics, preoperative tumor characteristics, histopathologic outcomes, and postoperative complication rates were reviewed and compared. Propensity score match analysis was conducted. RESULTS: A total of 345 patients (mean age: 58 ± 12 years; female: 36%) met the study inclusion criteria. Time interval from neoadjuvant treatment until surgery was longer for patients receiving consolidation chemotherapy (p < 0.001). Pathological complete response rates were comparable among patients receiving long-course chemoradiation therapy (20.3%) and short-course radiotherapy with consolidation chemotherapy (20.8%) compared to long-course chemoradiation therapy alone (14.6%) (p = 0.36). After the propensity score case-matched analysis, 48 patients in the long-course chemoradiation therapy with consolidation chemotherapy group were matched to 48 patients in the short-course radiotherapy with consolidation chemotherapy group. Groups were comparable with respect to age, sex, clinical stage, tumor location, type of surgical approach, and technique. Pathological complete response rate was comparable between the groups (20.8% and 18.8%, p = 0.99). LIMITATIONS: Study was limited by its retrospective nature. CONCLUSIONS: Among recent neoadjuvant treatment modalities, pathological complete response rates, and short-term clinical outcomes were comparable. Short-course radiotherapy with consolidation chemotherapy is safe and effective as long-course chemoradiation therapy as in a short-term period. See Video Abstract at http://links.lww.com/DCR/C174. LA RADIOTERAPIA DE CORTA DURACIÓN SEGUIDA DE QUIMIOTERAPIA DE CONSOLIDACIÓN ES SEGURA Y EFICAZ EN EL CÁNCER DE RECTO LOCALMENTE AVANZADO: RESULTADOS COMPARATIVOS A CORTO PLAZO DEL ESTUDIO MULTICÉNTRICO DE CASOS EMPAREJADOS POR PUNTAJE DE PROPENSION ANTECEDENTES: Las estrategias de quimioterapia de consolidación han demostrado una mejor respuesta patológica completa y tasas de reducción del estadio del tumor para pacientes diagnosticados con cáncer de recto. OBJETIVO: Comparar los resultados perioperatorios y las tasas de respuesta patológica completa entre diferentes estrategias de tratamiento neoadyu...

show abstract

Section: Conclusionesmentioning

confidence: 99%

Short-Course Radiotherapy Followed By Consolidation Chemotherapy Is Safe and Effective In Locally Advanced Rectal Cancer: Comparative Short-term Results of Multicenter Propensity Score Case-Matched Study

Benlice

Koç

Gulcu

et al. 2023

Diseases of the Colon &Amp; Rectum

View full text Add to dashboard Cite

show abstract

Efficacy of Neoadjuvant Hypofractionated Chemoradiotherapy in Elderly Patients with Locally Advanced Rectal Cancer: A Single-Center Retrospective Analysis

Kim,

Lee,

Park

et al. 2024

Cancers

View full text Add to dashboard Cite

Background/Objectives: The application of long-course chemoradiotherapy (LCRT) in elderly patients with locally advanced rectal cancer (LARC) can be challenging due to increased risks of complications associated with comorbidities and reduced functional status. This study aimed to assess the efficacy of neoadjuvant hypofractionated chemoradiotherapy (HCRT) in elderly patients with mid-to-low LARC. Methods: We performed a retrospective review of patients diagnosed with LARC from January 2013 to December 2020 and included those aged 70 years or older. Patients were categorized into three groups based on their treatment strategies: neoadjuvant HCRT (33 or 35 Gy in 10 fractions), neoadjuvant LCRT, and upfront surgery. Comparative analyses were performed on clinicopathological characteristics, short-term outcomes, and long-term survival outcomes among these groups. Results: Among the 296 patients included, 30 (10.1%) received HCRT, 195 (65.9%) underwent standard LCRT, and 71 (24.0%) underwent upfront surgery. The baseline characteristics showed that the HCRT group had a higher American Society of Anesthesiologists (ASA) score (ASA score 3 or 4, HCRT 43.3% vs. LCRT 16.9% vs. upfront surgery 15.5%, p = 0.002). The HCRT group showed a significantly lower incidence of radiotherapy-related complications than the LCRT group (16.7% vs. 48.7%, p = 0.001). However, the rate of pathological complete response was significantly lower in the HCRT group (10.0% vs. 15.4%, p = 0.002). The 3-year relapse-free survival (83.0% vs. 77.2% vs. 83.2%; p = 0.411), 3-year local recurrence-free survival (93.1% vs. 93.2% vs. 93.5%; p = 0.464), and 5-year overall survival (65.1% vs. 67.0% vs. 67.7%; p = 0.682) were not significantly different between the three groups. Multivariate analysis also showed that the treatment strategy was not associated with survival outcomes. Conclusions: Neoadjuvant HCRT demonstrated reduced radiotherapy-related complications and acceptable long-term oncologic outcomes. Therefore, neoadjuvant HCRT may be considered as a viable alternative for elderly patients with LARC.

show abstract

Short course radiotherapy and delayed surgery for locally advanced rectal cancer in frail patients: is it a valid option?

Cited by 2 publications

References 50 publications

Short-Course Radiotherapy Followed By Consolidation Chemotherapy Is Safe and Effective In Locally Advanced Rectal Cancer: Comparative Short-term Results of Multicenter Propensity Score Case-Matched Study

Short-Course Radiotherapy Followed By Consolidation Chemotherapy Is Safe and Effective In Locally Advanced Rectal Cancer: Comparative Short-term Results of Multicenter Propensity Score Case-Matched Study

Efficacy of Neoadjuvant Hypofractionated Chemoradiotherapy in Elderly Patients with Locally Advanced Rectal Cancer: A Single-Center Retrospective Analysis

Contact Info

Product

Resources

About