Abstract
BackgroundTo evaluate clinical outcome after preoperative short-course radiotherapy for rectal cancer with twice daily fractions of 2.9 Gy to a total dose of 29 Gy and adjuvant chemotherapy for pathological stage UICC ≥ II.Methods118 patients (median age 64 years; male : female ratio 2.5 : 1) with pathological proven rectal cancer (clinical stage II 50%, III 41.5%, IV 8.5%) were treated preoperatively with twice daily radiotherapy of 2.9 Gy single fraction dose to a total dose of 29 Gy; surgery was performed immediately in the following week with total mesorectal excision (TME). Adjuvant 5-FU based chemotherapy was planned for pathological stage UICC ≥ II.ResultsAfter low anterior resection (70%) and abdominoperineal resection (30%), pathology showed stage UICC I (27.1%), II (25.4%), III (37.3%) and IV (9.3%). Perioperative mortality was 3.4% and perioperative complications were observed in 22.8% of the patients. Adjuvant chemotherapy was given in 75.3% of patients with pathological stage UICC ≥ II. After median follow-up of 46 months, five-year overall survival was 67%, cancer-specific survival 76%, local control 92% and freedom from systemic progression 75%. Late toxicity > grade II was observed in 11% of the patients.ConclusionsPreoperative short-course radiotherapy, total mesorectal excision and adjuvant chemotherapy for pathological stage UICC ≥ II achieved excellent local control and favorable survival.
Highlights
To evaluate clinical outcome after preoperative short-course radiotherapy for rectal cancer with twice daily fractions of 2.9 Gy to a total dose of 29 Gy and adjuvant chemotherapy for pathological stage UICC ≥ II
We report on a phase II study for rectal cancer clinical stage UICC ≥ II with neoadjuvant short-course radiotherapy followed by immediate total mesorectal excision (TME) surgery
Radiotherapy was delivered according to protocol in 94.1% of the patients; in 7 patients, radiotherapy was delivered on three days with twice daily 2.9 Gy and two days with a single fraction of 5 Gy
Summary
To evaluate clinical outcome after preoperative short-course radiotherapy for rectal cancer with twice daily fractions of 2.9 Gy to a total dose of 29 Gy and adjuvant chemotherapy for pathological stage UICC ≥ II. Multimodality treatment for rectal cancer is well established for more than 20 years after adjuvant radiochemotherapy has shown to improve overall survival [1]. Significant progress has been made in surgical, radiation and medical therapy: total mesorectal excision (TME) has become a surgical standard [2] and neoadjuvant radiotherapy (± chemotherapy) improved outcome compared to postoperative treatment. Patients needed to have pathological proven rectal cancer UICC stage II to IV at any age and Karnofsky index > 70. Inclusion of stage IV was limited to patients who presented with potentially resectable hepatic metastases
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