Abstract
e15145 Background: Pelvic MRI can identify rectal cancer patients at risk of an incomplete (R1) resection, allowing pre-operative treatment, usually with pelvic chemo-radiotherapy (CRT) over 5 weeks. Co-morbidities (eg IHD) may make CRT high risk, & SCRT with delayed surgery 8-10 weeks later may be an option, but with relatively little published data on efficacy. Methods: Between 2004 & 2016 our database identified 573 patients with MRI defined high risk rectal adenocarcinomas, and 55 (9.6%) had SCRT & delayed surgery. Results: Patient characteristics: m 35, F 20, mean age 75 years (55- 90). Main co-morbidities were active IHD & frailty. Major post-operative complications were an anastomic leak in 1 (1.8%) patient & septicaemia/shock in 1 (1.8%) patient, with the latter being the only 30 day post-operative death (1.8%). The R1 resection rate was 7 (12.7%), affecting the circumferential resection margin (CRM) in 6, with 2 subsequently developing local recurrence. 4 CRM +ve patients are dead, all of systemic relapse. Distal margin involved in 1 patient, alive with no recurrence on follow up. Local recurrence (with systemic relapse) occurred in 1 patent with a clear CRM, 4 years after SCRT/surgery. Overall local recurrence rate was 5.4%. Pathology response was minimal 4 (7.3%), partial 28 (51%), good partial 15 (27%), & complete (pCR) 8 (14.5%). The 5 year disease specific survival rates, accepting small numbers in each group, were 60% for minimal, 96% for partial, 93% for good partial & 100% for pCR patients respectively. Systemic relapse occurred in 12 (22%) patients, with liver surgery & liver ablation in 2 patients respectively. 18 (33%) patients have died, 10 of infection, 2 of IHD, 2 of progressive disease, 2 of separate cancers, & 2 unknown. Conclusions: In a MRI defined high risk rectal cancer population & co-morbidities, the outcomes from SCRT with delayed surgery 8-10 weeks later are similar to CRT, & a reasonable option to consider.
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