Comparative postoperative complications in locally advanced rectal cancer patients post total neoadjuvant: short-course radiation vs. long-course radiation
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Abstract
BACKGROUND: Colorectal cancer is a major health concern in Thailand, with a high incidence rate and a significant risk of metastasis. Standard therapies include surgery, radiation, and chemotherapy. While short-course radiation (SCRT) is less frequently used due to potential side effects, studies suggest no significant differences in complication rates between SCRT and long-course radiation (LCRT).
OBJECTIVE: To compare postoperative complications in locally advanced rectal cancer patients receiving induction chemotherapy followed by either SCRT or LCRT before surgery over six years.
METHODS: A retrospective study was conducted among patients with locally advanced rectal cancer who received induction chemotherapy followed by either SCRT or LCRT at Chiangrai Prachanukroh Hospital, Thailand, between 2019 and 2024.
RESULTS: Among 44 patients, 31 underwent induction chemotherapy followed by SCRT, and 13 received LCRT. The SCRT group had higher median blood loss (300 ml vs. 150 ml, p=0.175) but not statistically significant difference in complications. Anastomotic leakage was observed in two SCRT patients and one LCRT patient (p=0.882). Perineal wound complications, bowel ileus, and obstruction rates were comparable. Clinical T4 stage was significantly associated with blood loss requiring transfusion (RR 2.33, 95% CI: 1.08–5.03, p=0.037).
CONCLUSIONS AND RECOMMENDATIONS: SCRT and LCRT resulted in similar rates of postoperative complications. These findings suggest that short-course radiotherapy may be a viable option, particularly when long-course treatment is not feasible.
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