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Altered fractionation short-course radiotherapy for stage II-III rectal cancer: a retrospective study.

ABSTRACT: PURPOSE:To report the long-term outcomes of neoadjuvant altered fractionation short-course radiotherapy in 271 consecutive patients with stage II-III rectal cancer. PATIENTS AND METHODS:This was a retrospective single institution study with median follow-up of 101?months (8.4?years). Patients who were alive at the time of analysis in 2018 were contacted to obtain functional outcome data (phone interview). Radiotherapy consisted of 25?Gy in 10 fractions of 2.5?Gy administered twice daily. Median time interval to surgery was 5?days. RESULTS:Local relapse was observed in 12 patients (4.4%) after a median of 28?months. Overall survival after 5 and 10?years was 73 and 55.5%, respectively (corresponding disease-free survival 65.5 and 51%). Of all patients without permanent stoma, 79% reported no low anterior resection syndrome (LARS; 0-20 points), 9% reported LARS with 21-29 points and 12% serious LARS (30-42 points). CONCLUSION:The present radiotherapy regimen was feasible and resulted in low rates of local relapse. Most patients reported good functional outcomes.

SUBMITTER: Geinitz H

PROVIDER: S-EPMC7227338 | biostudies-literature | 2020 May

REPOSITORIES: biostudies-literature

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Altered fractionation short-course radiotherapy for stage II-III rectal cancer: a retrospective study.

Geinitz Hans H Nieder Carsten C Kocik Lukas L Track Christine C Feichtinger Johann J Weingartner Theresa T Spiegl Kurt K Füreder-Kitzmüller Barbara B Kaufmann Johanna J Seewald Dietmar H DH Függer Reinhold R Shamiyeh Andreas A Petzer Andreas L AL Kiesl David D Hammer Josef J

Radiation oncology (London, England) 20200514 1

<h4>Purpose</h4>To report the long-term outcomes of neoadjuvant altered fractionation short-course radiotherapy in 271 consecutive patients with stage II-III rectal cancer.<h4>Patients and methods</h4>This was a retrospective single institution study with median follow-up of 101 months (8.4 years). Patients who were alive at the time of analysis in 2018 were contacted to obtain functional outcome data (phone interview). Radiotherapy consisted of 25 Gy in 10 fractions of 2.5 Gy administered twice ...[more]

PMID: 32410643

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Project description:Non-operative management of rectal cancer is increasingly being used in selected patients. Most reports include patients treated with chemoradiotherapy (CRT) before inclusion into a Watch & Wait (W&W) programme. The aim of this study was to report outcomes from a single-centre W&W programme involving a large cohort of patients. Patients treated with chemoradiotherapy (CRT) or short-course radiotherapy (SCRT) with or without chemotherapy, between 2008 and 2020, who showed signs of a clinical complete response (cCR) were reviewed. Patients were assessed using digital rectal examination, flexible endoscopy, carcinoembryonic antigen measurement, MRI, and CT imaging, discussed at the multidisciplinary tumour board meeting, and followed up in a dedicated W&W programme as from 2015. Outcomes including regrowth and 3-year survival (time to regrowth or death) were prospectively evaluated. Of 142 patients who were assessed, 88 fulfilled the criteria for cCR. Treatment before cCR included CRT, SCRT with chemotherapy, and SCRT alone in 16 (18 per cent), 28 (32 per cent), and 44 (50 per cent) patients, respectively. Patients treated with CRT and SCRT with chemotherapy had more advanced clinical T- and N-stage, compared with patients treated with SCRT alone (clinical T-stage > 2: 81 per cent and 89 per cent versus 47 per cent, respectively; clinical N-stage > 0: 75 per cent and 93 per cent versus 68 per cent, respectively). Overall rate of regrowth was 19 per cent, with 31 per cent, 21 per cent, and 14 per cent following CRT, SCRT with chemotherapy, and SCRT alone, respectively. Uni- and multivariable analyses evaluating the clinical parameters revealed no statistically significant associations with risk of local regrowth. All but one patient with regrowth underwent salvage surgery. The 3-year survival rate (death with regrowth as competing risk) was 93 per cent, with no significant difference between treatment groups. In this cohort of W&W patients, the vast majority received SCRT with or without chemotherapy and results consistent with previous W&W reports were obtained. No statistically significant differences in terms of regrowth rate were obtained when comparing CRT, SCRT with chemotherapy, and SCRT alone. SCRT can induce sustained cCR and may precede a W&W strategy.

Dataset Information

Altered fractionation short-course radiotherapy for stage II-III rectal cancer: a retrospective study.

Publications

Altered fractionation short-course radiotherapy for stage II-III rectal cancer: a retrospective study.

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