Preoperative Short-Course Radiotherapy and Surgery versus Surgery Alone for Patients with Rectal Cancer: A Propensity Score-Matched Analysis at 18-Year Follow-Up.

Radoslaw Pach,Antoni Szczepanik,Marek Sierzega,Piotr Richter,Natalia Papp

doi:10.3390/biomedicines9070725

Radoslaw Pach, Antoni Szczepanik + Show 3 more

Open Access

https://doi.org/10.3390/biomedicines9070725

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Abstract

A significant problem for long-term rectal cancer survivors may be the late toxicity of radiotherapy. It creates the possible risk of developing second primary malignancy and a theoretical decrease in overall survival. This study aimed to assess the influence of short-course preoperative radiotherapy in patients with locally advanced rectal cancer on overall survival, local recurrence rate, and second malignancy at 18-year follow-up. The rectal cancer trial was conducted in a single tertiary center between February 1992 and June 2006. A total of 389 patients with locally advanced rectal cancer (cT2-cT4, cN0/+, cM0) were included in the study. Preoperative radiotherapy was conducted in 148 patients and 241 patients underwent surgery alone. The propensity-matched group consisted of 105 patients operated on after radiotherapy and 105 controls. The number of local recurrences was 7 (6.7%) in the preoperative radiotherapy group and 22 (21%) in the surgery alone group (p = 0.016). The 18-year survival analysis showed no survival benefit in the preoperative radiotherapy group (38% versus 48%, p = 0.107) but improved recurrence-free survival (81% versus 58%, p = 0.001). The preoperative short-course radiotherapy significantly decreases the risk of local recurrence in locally advanced rectal cancer and may improve recurrence-free survival without an increased risk of second primary malignancy.

Highlights

Published: 24 June 2021A total of one-third of colorectal cancer cases consist of rectal cancers
This study aimed to assess the influence of short-course preoperative radiotherapy in patients with locally advanced rectal cancer on overall survival, local recurrence rate, and second malignancy at 18-year follow-up
The matched group consisted of 105 patients operated on after short-course preoperative radiotherapy and 105 patients who only underwent surgical treatment

Summary

Introduction

A total of one-third of colorectal cancer cases consist of rectal cancers. The last few decades have demonstrated a total reduction in local recurrence rates of rectal neoplasms. This may be due to changes in the treatment strategies and surgical techniques. The first shift of paradigm was the introduction of the total mesorectal excision (TME) technique [1]. The second was the implementation of preoperative radiotherapy. Surgery still remains the mainstay of rectal cancer treatment

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