Short-Course Radiotherapy in Locally Advanced Rectal Cancer

Abstract

INTRODUCTION: To date, we do not know the best therapeutic scheme in locally advanced rectal cancer when patients are older or have comorbidities. METHODS: In 2009, we established a prospective treatment protocol that included short-course preoperative radiotherapy (RT) with standard surgery +/− chemotherapy in frail patients, mostly older than 80 years or with comorbidities. RESULTS: We included 87 patients; the mean follow-up was 43.5 months (0.66–106.3). Disease-specific survival and disease-free survival at 36 months were 86.3% and 82.8%; at 60 months, they were 78.2% and 78%, respectively, with a local recurrence rate of 2.5%. The rate of late radiotoxicity was 9% in the form of sacral insufficiency fracture and small bowel obstruction with one death. The interval before surgery varied according to the involvement of the mesorectal fascia, but it was less than 2 weeks in 45% of cases. The rate of R0 was 95%. Surgical complications included abdominal wound dehiscence (3.5%), anastomotic leak (2.4%), and reoperations (11.5%). Downstaging was observed in 51% of the cases, regardless of the interval before surgery. DISCUSSION: Therapeutic outcomes in our group of elderly patients and/or patients with comorbidities with neoadjuvant short-course RT are such as those of the general population treated with neoadjuvant RT-chemotherapy, all with acceptable toxicity. Therefore, this treatment scheme, with short-course preoperative RT, would be the most appropriate in this group of patients.

Prognostic Value of the Circumferential Resection Margin After Curative Surgery for Rectal Cancer: A Multicenter Propensity Score-Matched Analysis

“…However, it should be noted that the percentage of patients who received only chemotherapy or RT alone was low. In addition, as previously described in the literature, 24,34 no differences have been found between short-course and long-course neoadjuvant RT in terms of long-term oncologic outcomes. We found that patients with CRM+ had a higher risk of LR than those with CRM−.…”

Protocol: The role of defunctioning stoma prior to neoadjuvant therapy for locally advanced colonic and rectal cancer-A systematic review

“…The former involves the administration of a total of 45 Gy delivered by daily 2.8–2 Gy over the course of 5 weeks with concomitant 5-FU based chemotherapy followed by planned resection in 6–8 weeks after completion. The latter includes the delivery of 5x 5 Gy over the course of 1 week with planned surgery in the following week [ 16 ].…”

“…LCCRT and SCRT have largely demonstrated similar results when assessing the rates of 5-year distant recurrence (27–30%),5-year survival (70–74%)and late adverse grade 3–4 toxicity (5.8–8.2%) [ 17 ]. The comparable efficacy of SCRT and reduced toxicity means that it is considered an equally effective option in treatment of locally advanced rectal cancer in the frail patient population in whom chemotherapy associated toxicity may pose further delays to the start date of surgery [ 16 ]. Recently, the effect of differing intervals between neoadjuvant therapy and surgery and its effect on oncological outcomes and complication profile has been subject of ongoing research.…”

Organ Sparing for Locally Advanced Rectal Cancer after Neoadjuvant Treatment Followed by Electrochemotherapy

“…TME is the gold standard in rectal cancer surgery and is comprised of resection of the rectum together with the fatty tissue surrounding the rectum [45]. For LARC, therapy consists of preoperative chemo-radiation therapy (pCRT) or radiotherapy alone followed by TME [51][52][53][54][55][56][57][58][59][60][61][62].…”