Treatment pattern and outcome of locally advanced rectal cancer in Tikur Anbessa Specialized Hospital (TASH), Addis Ababa, Ethiopia: An institution-based cross-sectional study.

Abstract

e15640 Background: The standard management of locally advanced rectal cancer (LARC) is neo-adjuvant concurrent chemo radiation (CCRT) followed by total meso-rectal excision. Recently there is an increased interest in total neo-adjuvant treatment (TNT). Most patients with rectal cancer in developing countries present in advanced stage for several reasons including lack of resources and delayed health seeking behavior. Most patients are not able to get standard management. This study tries to assess treatment patterns and outcomes in LARC. Methods: A cross-sectional study was conducted in patients with LARC that are treated at TASH from Jan 1, 2020 up to Sept. 2022. The data was collected from Patient’s cards using a pre-structured format that included demographic data, laboratory, pathological and imaging information. Data analysis was conducted by using IBM SPSS version 25. Results: 100 patients were included in the study, 51% were male. The median (range) age at diagnosis was 45.5 (20-86) years. 81% of patients came to our center without getting any oncologic treatment and 75.3% of them were presented on a multi-disciplinary tumor board for their treatment decision. Upfront surgery was decided in 48.1% (39/81) of patients. Standard neo-adjuvant treatment of either TNT or CCRT was decided in 23.4% (19/81) and 8.6% (7/81) of patients respectively. There is no significant association between tumor location, TNM stage, mesorectal fascia status and first treatment decision. Only 12 (14.8%) patients were able to finish their whole treatment plan. The most common reason for not finishing all treatment was prolonged radiation waiting time, with the median (range) waiting time of 10 ± 7.1 (1-26) months. From 81 treatment naive patients, 79 were decided to have surgery; and 59.5% (47/79) underwent the planned surgery with 89.9% R0 resection rate. R0 resection rate in patients who undergo upfront surgery was 91.2% (31/34). Neo-adjuvant chemotherapy was given to 34.6% (28/81); and only 18% (5/28) underwent subsequent surgery. The most common reason for not undergoing subsequent surgery was disease progression 43.5% (10/23) during or after finishing the neo-adjuvant chemotherapy. Only 24% of the study participants received radiotherapy. From the patients who took radiotherapy, only two patients received short course radiotherapy. Conclusions: Treatment decisions for rectal cancer in our study did not conform to standard treatment recommendations. Upfront surgery maybe a better option than neoadjuvant chemotherapy, since timely administration of standard neoadjuvant treatment is not possible. Alternative radiotherapy treatment options like short course radiotherapy may be better in resource limited setting to alleviate the longer radiotherapy waiting time.