Abstract
Aims: To assess acute toxicities and treatment tolerance in patients of carcinoma rectum of NACTRT at a tertiary care centre of North-East India. Materials and Methods: A total of 50 patients of histologically proven Rectal Adenocarcinoma recruited from July 2022 to May 2023 were included in the study. All patients were planned for either NACTRT (n=44) or Total Neoadjuvant Treatment (TNT)(n=6) followed by assessment for surgery. A total dose of 50.4Gy/28# was planned with concurrent oral chemotherapy with T. Capecitabine at a dose of 825 mg/m2 twice daily. Acute toxicities were assessed using RTOG grading criteria. Patients’ toxicity assessment was done weekly with clinical examination and laboratory parameters. Patients were also assessed at the end of RT and 4 weeks post completion of NACTRT. Results: All patients could complete the prescribed dose of EBRT (50.4Gy/28#) over a period of 6 weeks. On toxicity assessment, Grade-I dermatitis was seen in 14 patients (56%), Grade-II in 14 patients (54%), Grade-III in 2 patients (7.6%). In lower gastrointestinal toxicities, Grade-I diarrhea occurred for 4 patients (50%), Grade-II diarrhea in 3 patients (37.5%) and Grade III diarrhea in 1 patient (7.6%). Grade-I genitourinary toxicity was observed in 4 patients (8%). Hematological toxicities were seen for 40 patients of which Grade-I, Grade-II, Grade-III Anemia were seen in 10 (38.4%), 14 (54%), 2 (7.6%) patients respectively. Grade 1 and Grade 2 leucopenia were seen in 4 (57%) and 3 (43%) patients respectively. Deranged LFT was seen for 7 patients (15%), out of whom dose modifications were required for 5 patients (10%). Treatment was put on hold for 3 patients (6%) for 3 days due to grade 3 toxicities. Conclusion: NACTRT in rectal cancer patients was associated with acceptable toxicities and treatment tolerance. Modern EBRT techniques like IMRT should be evaluated in an effort to further reduce the radiation related toxicities.
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