Outcomes of preoperative radiotherapy in rectal cancer: a single institute experience.
Keywords:
preoperative radiotherapy, short course radiotherapy, rectal cancerAbstract
Background: The combination of preoperative radiotherapy, total mesorectal excision surgery and systemic chemotherapy contributed to improved disease control of rectal cancer in modern era. Different radiotherapy fractionation has been used in clinical practice in Thammasat hospital.
Objective: To evaluate treatment outcomes of rectal cancer patients who underwent preoperative radiotherapy at Thammasat hospital.
Materials and methods: Retrospective chart review of rectal cancer patients who underwent preoperative radiotherapy at Thammasat hospital from October 1,2015 to January 31,2021.
Results: A total of 70 rectal cancer patients underwent preoperative radiotherapy. Most patients were in a locally advanced stage. Sixty-three patients received conventional fractionation radiotherapy concurrent with intravenous 5-fluorouracil or oral capecitabine followed by surgery and adjuvant chemotherapy. The median dose of conventional fraction was 50.4 Gy. Preoperative short-course radiotherapy of 25 Gy in 5 fractions followed by surgery and adjuvant chemotherapy was given in seven patients. All of the patients who received short course radiotherapy and 80.95% of patients who received long-course radiotherapy achieved complete resection. Pathological complete response was found in 11.4% with all being the subset that received long course radiotherapy. From the median follow-up time of 20.5 month, 2-year overall survival was 88.5%, 2-year progression-free survival was 49.3%, 2-year locoregional recurrence free was 70.5% and 2-year distant metastasis free survival was 58%. A total of 30 patients developed disease failure. Eight patients (11.4%) had loco-regional recurrence as the first recurrence, 4 of them had persistent disease (5.7%); 22 developed distant metastasis (32.8%) including one who had synchronous loco-regional and distant metastasis (1.4%). Complete resection was shown to improve progression free survival in multivariate analysis (HR 0.11, 95%CI 0.05-0.27, p value<0.001).
Conclusions: Preoperative radiotherapy, both short course and long course fractionation, facilitate complete resection in rectal cancer. Distant metastasis is the most common cause of disease recurrence.
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