Should Short-Course Neoadjuvant Radiation Therapy Be Applied for Low-Lying Rectal Cancer? A Systematic Review and Meta-Analysis of the Randomized Trials

Socha, Joanna; Kairevičė, Laura; Kępka, Lucyna; Michalski, Wojciech; Spałek, Mateusz; Paciorek, Karol; Bujko, Krzysztof

doi:10.1016/j.ijrobp.2020.06.077

Cited by 7 publications

(4 citation statements)

References 32 publications

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“…Impairment is more often reported in patients who underwent pre-operative treatment and surgery compared to surgery alone [3][4][5][6]. Pre-operative short-course radiotherapy (scRT) with immediate surgery and chemoradiotherapy (CRT) (with delayed surgery) are associated with comparable late toxicity [7]. Postoperative chemotherapy, having the aim to decrease systemic recurrences, further adds morbidity [8].…”

Section: Discussionmentioning

confidence: 99%

Quality of life and late toxicity after short-course radiotherapy followed by chemotherapy or chemoradiotherapy for locally advanced rectal cancer – The RAPIDO trial

Dijkstra

Hospers

Kranenbarg

et al. 2022

Radiotherapy and Oncology

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Section: Discussionmentioning

confidence: 99%

Quality of life and late toxicity after short-course radiotherapy followed by chemotherapy or chemoradiotherapy for locally advanced rectal cancer – The RAPIDO trial

Dijkstra

Hospers

Kranenbarg

et al. 2022

Radiotherapy and Oncology

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“…A multimodal approach has become the standard of care for LARC. In addition, the short-course NA-RT regimen of 25 Gy/5 fractions is one of the most common regimens [1][2][3][4][5][6][7][8][9][10][11][12][13]. The mSC-RT using an accelerated hyperfractionated regimen seems to be a treatment regimen with a favorable therapeutic ratio, with a high BED calculation for tumor in comparison with the conventional short-course NA-RT regimen [14].…”

Section: Discussionmentioning

confidence: 99%

“…The Polish trial and the TROG 01.04 trial have revealed that there are no significant differences in overall survival (OS), local control (LC), distant failure, relapsefree survival (RFS), and late toxicities in randomized controlled trials comparing the shortand long-course NA-RT [5,6]. Moreover, meta-analyses have also shown that there are no significant differences in LC between short-course and long-course NA-RT [7,8].…”

Section: Introductionmentioning

confidence: 99%

Neoadjuvant Modified Short-Course Radiotherapy Followed by Delayed Surgery for Locally Advanced Rectal Cancer

Doi

Yokoyama

Beppu

et al. 2021

Cancers

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This study aimed to assess the clinical outcomes and predictive factors of neoadjuvant modified short-course radiotherapy (mSC-RT) for locally advanced rectal cancer (LARC). Data from 97 patients undergoing mSC-RT followed by radical surgery for LARC were retrospectively analyzed. A 2.5 Gy dose twice daily up to a total dose of 25 Gy in 10 fractions was administered through mSC-RT, and this was delivered with oral chemotherapy in 95 (97.9%) patients. Radical surgery was performed 6 (range, 3–13) weeks after mSC-RT. The median follow-up among surviving patients was 43 (8–86) months. All patients completed neoadjuvant radiotherapy with no acute toxicity grade ≥ 3. Three- and five-year local control rates were 96.3% and 96.3%, respectively. Three- and five-year overall survival (OS) rates were 92.7% and 79.8%, respectively. Univariate analyses revealed that poor OS was associated with no concurrent administration of capecitabine, C-reactive-protein-to-albumin ratio ≥ 0.053, carcinoembryonic antigen ≥ 3.4 ng/mL, and neutrophil-to-lymphocyte ratio (NLR) ≥ 1.83 (P = 0.045, 0.001, 0.041, and 0.001, respectively). Multivariate analyses indicated that NLR ≥ 1.83 was independently associated with poor OS (p = 0.018). mSC-RT followed by delayed surgery for LARC was deemed feasible and resulted in good clinical outcomes, whereas poor OS was associated with high NLR.

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“…We searched the literature and found 2 randomized trials 1,2 and 2 systematic reviews with meta-analyses of pooled findings evaluating the efficacy of SCRT. 4,5 Findings indicated that SCRT achieves similar rates of local control and overall survival compared with LCCRT and improved outcomes over surgery alone. Nevertheless, because SCRT has not been available as long as LCCRT, evidence regarding long-term outcomes is limited.…”

Section: Casementioning

confidence: 99%

Shared Decision-Making and Short-Course Radiotherapy for Operable Rectal Adenocarcinoma

Col

Haugen

2022

Journal of Wound, Ostomy &Amp; Continence Nursing

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BACKGROUND: As new treatment options for colorectal cancer (CRC) emerge, physicians and WOC nurses must be prepared to assist patients to choose care that meets their needs and preferences. A patient with T2N0M0 rectal adenocarcinoma was offered the US current standard of practice; he was not offered alternative treatment options. This case study emphasizes the need to ensure patients are offered all reasonable options for treatment. Shared decision-making is a process that helps patients actively participate in their heath choices rather than exclusively relying on the judgment of a health care provider. CASE: Mr J was a 70-year-old man with operable CRC who sought care at a health care facility in his community. He was offered a single option, based on standard of care for this tumor stage: long-course neoadjuvant chemoradiotherapy followed by surgery and additional chemotherapy. After seeking a second opinion at a cancer care center in another state, Mr J chose to undergo a viable alternative treatment option (short-course radiotherapy, followed by surgery, with chemotherapy contingent on his nodal status post-surgery). No nodal involvement was found post- surgery (T2N0M0) enabling him to avoid postoperative chemotherapy. CONCLUSIONS: This case illustrates the need for all health care providers and carers to regularly engage in shared decision-making when choosing among treatment options. In this case, short-course radiotherapy offered Mr J a shorter duration of treatment and avoided the risk for adverse side effects associated with chemotherapy, resulting in improved health-related quality of life. Initial omission to disclose all treatment options to Mr J may have reflected the preferences of the surgeon, institutional financial pressures, or discomfort with shared decision-making, but it failed to provide him with full range of options, given his diagnosis and tumor stage. All members of the patient's care team, including the WOC nurse, play a pivotal role in ensuring transparency in medical care, including advocating for shared decision-making where patients are made aware of all viable treatments, followed by supporting the patient as they reach a decision.

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Should Short-Course Neoadjuvant Radiation Therapy Be Applied for Low-Lying Rectal Cancer? A Systematic Review and Meta-Analysis of the Randomized Trials

Cited by 7 publications

References 32 publications

Quality of life and late toxicity after short-course radiotherapy followed by chemotherapy or chemoradiotherapy for locally advanced rectal cancer – The RAPIDO trial

Quality of life and late toxicity after short-course radiotherapy followed by chemotherapy or chemoradiotherapy for locally advanced rectal cancer – The RAPIDO trial

Neoadjuvant Modified Short-Course Radiotherapy Followed by Delayed Surgery for Locally Advanced Rectal Cancer

Shared Decision-Making and Short-Course Radiotherapy for Operable Rectal Adenocarcinoma

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