Hypofractionated short-course preoperative conformal radiotherapy versus long course conventional preoperative chemoradiotherapy in the management of locally advanced rectal cancer – Prospective randomized comparative study

Abstract

Introduction: Colorectal cancer (CRC) is the primary health problem worldwide. Besides survival, a significant problem in locally advanced rectal cancer is recurrence. Adding radiotherapy to surgery has been shown conclusively to improve local control for rectal cancer. Aim: To compare hypo fractionated short-course preoperative conformal radiotherapy versus long-course conventional preoperative chemoradiotherapy in the management of locally advanced rectal cancer. Materials and Methods: This prospective comparative study was conducted in 44 patients who grouped into ARM A (short course RT) for 22 patients and ARM B (long course Chemoradiotherapy) for 22 patients. Treatment protocol and follow up protocol was followed and the results were statistically analyzed and discussed. Results: Out of 44 patients, 22 patients had short-course radiotherapy (ARM A) and 22 patients had long course radio-chemotherapy (ARM B). In ARM A, 7 patients in stage T3NOMO, 2 patients in stage T3N1MO,9 patients in stage T4N0M0, 4 patients in stageT4N1M0,4patients had an interruption, 18 patients had no interruption, mean duration of diseases free survival is 354.59 125.86 days, 18 patients had a partial response, and 4 patients had stable diseases. In ARM B,5 patients in stage T3NOMO, 5 patients in stage T3N1MO, 7 patients in stages T4N0M0, 5 patients in stage T4N1M0, 14 patients had an interruption, 8 patients had no interruption, mean duration of diseases free survival is 414.27119.97 days, 19 patients had a partial response and 3 patients had stable diseases. Conclusion: Short-course neo-adjuvant radiotherapy using IMRT showed similar response rates and diseases free survival but less acute toxicity and short hospital stay when compared to the conventional long-course chemoradiotherapy. Keywords: Chemoradiotherapy, Preoperative treatment, Rectal cancer.