Abstract
To validate that a two-week short-course pre-operative radiotherapy regimen is feasible, safe, and effective for the management of elderly patients with locally advanced rectal cancer (LARC), we retrospectively analyzed 99 radiotherapy-naive patients ≥70 years of age with LARC. Patients received pelvic radiation therapy (3D-CRT 30Gy/10f/2w) followed by TME surgery; some patients received adjuvant chemotherapy. The primary endpoint was OS, while the secondary endpoints were DFS, safety and response rate. The median follow-up time was 5.1 years. The 5-year OS and DFS rates were 58.3% and 51.2%, respectively. The completion rate of radiotherapy (RT) was 99.0% (98 of 99). Grade 3 acute adverse events, which resulted from RT, occurred in only 1 patient (1.0%). In addition, no grade 4 acute adverse events induced by RT were observed. All 99 patients (100%) were able to undergo R0 surgical resection, and 68.6% of the patients received sphincter-sparing surgery. The rate of occurrence of clinically relevant post-operative complications was 12.1%. Three patients (3.0%) achieved pathologic complete responses, and forty-three patients (43.4%) achieved pathologic partial responses. The rates of T-downsizing and N-downstaging were 30.3% and 55.7%, respectively. Therefore, we believe that a two-week short-course pre-operative radiotherapy is feasible in elderly patients with resectable LARC.
Highlights
Colorectal carcinoma, which is one of the most prevalent cancers worldwide, is the second leading cause of cancer-related death in most developed countrie[1]
Surgery alone cannot result in the best survival outcomes, especially due to the high risk of local recurrence, in cases of locally advanced rectal cancer (LARC, Stage II or Stage III, according to the American Joint Committee on Cancer, AJCC)
The short-course pre-operative radiation regimen for LARC was tested extensively in randomized trials[6,7,8,9]. This treatment resulted in a relative reduction in local recurrence of approximately 60% compared with surgery alone and was associated with acceptable toxicity
Summary
Colorectal carcinoma, which is one of the most prevalent cancers worldwide, is the second leading cause of cancer-related death in most developed countrie[1]. The short-course pre-operative radiation regimen for LARC was tested extensively in randomized trials[6,7,8,9]. This treatment resulted in a relative reduction in local recurrence of approximately 60% compared with surgery alone and was associated with acceptable toxicity. In addition to the lack of a significant difference between 3-year local recurrence rates and 5-year OS rates, the late toxicity rates, distant recurrence, and relapse-free survival were not significantly different between the arms[9] Overall, it appears that short-course RT provides effective local control and the same OS as long-course CRT schedules, and may be an appropriate choice in some situations. It is reasonable to suppose that, for elderly patients, short-course radiation followed by TME surgery may be feasible
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