Abstract
BackgroundThe purpose of this study was to compare short-course radiotherapy (SC) or neoadjuvant long-course chemoradiotherapy (LC) treatment for locally advanced rectal cancer patients.MethodsPatients with a diagnosis of locally advanced rectal cancer (LARC) who had undergone neoadjuvant radiotherapy before surgery between 2013 and 2018 at the medical center in China were included in this study. All patients’ MRI confirmed T2N+M0 or T3-4N0-3M0 clinical stages. Patients in the SC group received pelvic radiotherapy with a dose of 5 × 5 Gy (with or without chemotherapy at any time), followed by immediate or delayed surgery. Patients in the LC group received a dose of 50–50.4 Gy in 25–28 fractions, concomitantly with FOLFOX or capecitabine-based chemotherapy, followed by surgery 4–6 weeks later. All clinical data were retrospectively collected, and long-term follow-up was completed and recorded at the same time.ResultsA total of 170 were eligible to participate in this study, 32 patients in the SC group, and 138 in the LC group. The median follow-up time of living patients was 39 months. The disease-free survival (DFS) and overall survival (OS) rates in the SC group and LC group at 3 years, were, 84.9% versus 72.4% (P = 0.273) and 96.2% versus 87.2% (P = 0.510), respectively. The complete pathological response (pCR) rates in the SC group and LC group were, 25% versus 18.1% (the difference was not statistically significant, P = 0.375), respectively. However, the SC group had better node(N) downstaging compared to the LC group (P = 0.011).ConclusionsThere were no differences observed in DFS and OS between short-course radiotherapy and long-course chemoradiation, and both can be used as treatment options for patients with locally advanced rectal cancer.
Highlights
The purpose of this study was to compare short-course radiotherapy (SC) or neoadjuvant long-course chemoradiotherapy (LC) treatment for locally advanced rectal cancer patients
Preoperative radiotherapy followed by total mesorectal excision is the standard treatment for locally advanced rectal cancer
Short-course has the advantages of reduced cost and improved patient convenience as treatment is completed within a shorter time, while long-term chemoradiotherapy is closely related to higher sphincter preservation and lower surgical morbidity
Summary
The purpose of this study was to compare short-course radiotherapy (SC) or neoadjuvant long-course chemoradiotherapy (LC) treatment for locally advanced rectal cancer patients. CAO/ARO/AIO-94 III phase trial [3] compared preoperative and postoperative radiotherapy and chemotherapy in patients with locally advanced rectal cancer. Wang et al BMC Gastroenterol (2021) 21:277 decreased, and at 5 years, the cumulative local recurrence rate was reduced, establishing the status of preoperative radiotherapy and chemotherapy in locally advanced rectal cancer. There are two standard preoperative therapy options, including short-course radiotherapy (5 × 5 Gy) with immediate or delayed surgery, and long course chemoradiotherapy (45–50 Gy) with concurrent chemotherapy and surgical treatment after 4–8 weeks. Short-course has the advantages of reduced cost and improved patient convenience as treatment is completed within a shorter time, while long-term chemoradiotherapy is closely related to higher sphincter preservation and lower surgical morbidity. The current Chinese guidelines recommend long-term simultaneous radiotherapy and chemotherapy as grade I for preoperative treatment of middle and low rectal cancer in cT3/ T4N + , while short-term radiotherapy is recommended as grade II, and needs to be discussed in many disciplines before implementation [8]
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