Abstract
:ObjectiveThe purpose of this study was to evaluate the clinical outcome of preoperative short-course radiotherapy for rectal cancer patients.MethodsThe study group comprised 210 patients with pathologically proven resectable rectal cancer. Between 2001 and 2013, they were treated preoperatively with short-course radiotherapy (25 Gy delivered in five fractions), followed by total mesorectal excision. Adjuvant 5-fluorouracil-based chemotherapy was administered at the discretion of the treating physician, depending on the pathological stage.ResultsAfter a median follow-up of 57 months, the following 5-year survival rates were observed: overall survival—66.4%, disease-free survival—67.2%, locoregional relapse-free survival—91.7%, and distant metastases-free survival—71.5%. The local failure was observed in 15 patients. Ten patients (4.8%) achieved pathologic complete response. The multivariate analysis demonstrated the regional lymph node involvement to be statistically significant for unfavorable outcomes in terms of all estimated survival rates. Lymphovascular invasion was found to be a strong predictor of survival (HR = 1.68; 95% CI 1.29–3.55) and treatment failure (HR = 1.54; 95% CI 1.08–3.34). The presence of positive surgical circumferential margin was related to six times higher risk of locoregional recurrence. Early and late severe treatment-induced toxicity was reported in 1 and 7.6% patients, respectively.ConclusionsPreoperative short-course radiotherapy followed by total mesorectal excision and adjuvant chemotherapy allows to achieve excellent local control and favorable survival rates. The treatment-induced toxicity is acceptable.
Highlights
Over the last few decades, parallel to irrefutable benefits from dynamic socioeconomic changes in Poland, one can observe undesirable effects typical for highly developed countries
The objective of this study is to evaluate long-term results of short preoperative radiotherapy regimen in patients with rectal cancer treated in our center
Between 2001 and 2013, 424 rectal cancer patients were treated with short preoperative radiotherapy at the Maria Sklodowska-Curie Memorial Institute of Oncology in Kraków
Summary
Over the last few decades, parallel to irrefutable benefits from dynamic socioeconomic changes in Poland, one can observe undesirable effects typical for highly developed countries. In 2014, cancer accounted for about 25% of all deaths recorded in Poland. In 2013, according to the National Cancer Registry, nearly 5900 new rectal cancer cases were diagnosed and more than 3300 deaths resulting from rectal cancer were noted [2]. The abovementioned epidemiological data indicate a crucial role for the most efficient treatment determination in this large group of patients. There is still a lot of controversies relating to the optimal treatment course. Total mesorectal excision (TME) has been the gold standard for the surgical management of rectal cancer. Introduction of this procedure to surgical practice has resulted in significant improvements in local cure rates, compared to conventional
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