Preoperative Short Course Radiotherapy for Rectal Cancer Provides Excellent Disease Control and Toxicity: Results from a Single US Institution

Publication date: Available online 31 August 2016
Source:Practical Radiation Oncology
Author(s): Amit Roy, Pawinee Mahasittiwat, Ashley A. Weiner, Steven R. Hunt, Matthew G. Mutch, Elisa H. Birnbaum, Ira J. Kodner, Thomas E. Read, James W. Fleshman, Jeffrey R. Olsen, Robert J. Myerson, Parag J. Parikh
Purpose/ObjectivePreoperative short-course radiotherapy (SCRT) has rarely been utilized for rectal cancer in the United States (US), though two randomized phase III trials demonstrate equivalence to conventional chemoradiation (CRT)Bujko et al. (2006), Ngan S, Fisher R, Burmeister B, et al. Long-term Quality of Life in Patients Treated in TROG 01.04: A Randomized Trial Comparing Short Course and Long Course Preoperative Radiation Therapy for Rectal Cancer. Int. J. Radiat. Oncol (2012) and recent updates to national guidelines include this regimen as a treatment option. We sought to evaluate the efficacy and safety of preoperative SCRT followed by immediate surgery within one week to treat rectal cancer in the US setting.Methods and MaterialsAll patients treated with preoperative SCRT (4Gy x 5 fractions for total 20Gy) followed by planned surgery within one week at our institution were retrospectively evaluated. Censored cases with ≥2years of follow-up were included along with any disease failure or death. Patients with cM1 disease were excluded. Patients with yp stage II/III disease typically received adjuvant chemotherapy from the 1990s onwards. The primary outcomes were actuarial (Kaplan–Meier) five-year local control (LC), disease-free survival (DFS), and overall survival (OS) as well as late severe (≥ grade 3) toxicity.ResultsOur analysis included 202 consecutive patients with clinical stage I-III disease treated from 1977–2011. Median follow-up was 6.5years (range 2–29.2). Five-year disease outcomes were 95.9%±1.5% for LC, 76.4%±3.1% for DFS, and 84.6%±2.6% for OS. For patients with locally advanced rectal cancer (cT3–4 and/or cN+), five-year LC, DFS, and OS were 95.1%±2.1%, 73.3%±4.3%, and 80.6%±3.7%, respectively. The late severe toxicity rate was 11.4%.ConclusionsSCRT followed by immediate surgery is a safe and effective treatment for patients with rectal cancer in the US. Though SCRT has not been widely adopted, recent updates to the national guidelines for rectal cancer as well as financial pressures to reduce healthcare costs may lead to increased utilization of this treatment regimen in the future.



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