Abstract
Objective: In locally advanced non-metastatic rectal carcinoma, pre-operative radiotherapy is an acceptable alternative over post-operative radiation to improve locoregional control after radical surgery. There are two regimens of pre-operative radiotherapy – short-course radiotherapy (25 Gy/5 fractions/1 week) and long-course chemoradiotherapy (CRT) (50.4 Gy/28 fractions/5.5 weeks). Our study aimed to compare the pathological response, margin negative surgery rates, and treatment-related acute toxicities between these two approaches. Methods: Patients with histologically proven locally advanced, non-metastatic rectal adenocarcinoma were randomized into study group and control group – the study group received short-course radiotherapy (25 Gy/5 fractions/1 week) followed by surgery after 7–10 days of completion of radiotherapy and the control group received long-course radiotherapy (50.4 Gy/28 fractions/5.5 weeks) with concurrent capecitabine followed by surgery after 4–6 weeks of completion of radiotherapy. Histopathology reports were studied in both groups for the determination of pathological response of tumor and surgical margin status. All patients received adjuvant chemotherapy for 6 months with oxaliplatin and capecitabine. For the assessment of treatment-related acute toxicities, patients were examined during the entire course of treatment. Results: Overall pathological response (complete response+partial response) was 81.25% in the study arm and 86.66% in the control arm. Complete response rate was 15% in the study arm and 25% in the control arm. Margin negative surgery rates were higher in long-course CRT than short-course radiotherapy (90% vs. 82%), but it was statistically insignificant. Radiation-induced acute skin reactions (less than Grade 2) were significantly higher in long-course CRT arm (p=0.003). Conclusion: There is no significant difference between pre-operative short-course radiotherapy and long-course concomitant CRT in terms of efficacy and acute toxicity profile. Thus, with our limited resources and huge patient load, short-course radiotherapy can be used as an acceptable alternative to long-course CRT.
Highlights
According to GLOBOCAN 2018 in India, around 24,251 new cases of rectal carcinoma occurred in 2018 contributing 2.6% of all cancer-related deaths [1,2]
Even with the advent of total mesorectal excision (TME), to reduce the chances of local recurrence [3-9]; there were still incidences of local recurrences opening up the potential role of adjuvant therapy in the form of radiotherapy, chemotherapy, or both to improve local control after TME [10]
Longcourse radiotherapy provides time for adequate downstaging of tumor leading to better respectability, margin negative surgery, and higher pathological complete response rates and better chances of sphincter sparing surgery
Summary
According to GLOBOCAN 2018 in India, around 24,251 new cases of rectal carcinoma occurred in 2018 contributing 2.6% of all cancer-related deaths [1,2]. Neoadjuvant treatment has the advantages of tumor downstaging and subsequent higher potential of margin negative surgery, sphincter preservation, and reduced normal tissue toxicity [11,12]. Longcourse radiotherapy provides time for adequate downstaging of tumor leading to better respectability, margin negative surgery, and higher pathological complete response (pCR) rates and better chances of sphincter sparing surgery. It has a long duration of treatment so requires prolonged hospital stay or repeated hospital visits, greater economic expenses, and more expenditure of resources
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