A PROSPECTIVE COMPARATIVE STUDY ON LOCALLY ADVANCED RECTAL CARCINOMA TREATED WITH PRE-OPERATIVE SHORT-COURSE RADIOTHERAPY VERSUS LONG-COURSE RADIOTHERAPY WITH CONCOMITANT CHEMOTHERAPY

LINKON BISWAS; AVIK MAJI; SHYAM SHARMA; SRIKRISHNA MANDAL

doi:10.22159/ajpcr.2022.v15i3.43967

Authors

LINKON BISWAS Department of Radiotherapy, NRS Medical College and Hospital, Kolkata, West Bengal, India.
AVIK MAJI Department of Radiotherapy, NRS Medical College and Hospital, Kolkata, West Bengal, India.
SHYAM SHARMA Department of Radiotherapy, North Bengal Medical College and Hospital, Darjeeling, West Bengal, India.
SRIKRISHNA MANDAL Department of Radiotherapy, North Bengal Medical College and Hospital, Darjeeling, West Bengal, India.

DOI:

https://doi.org/10.22159/ajpcr.2022.v15i3.43967

Keywords:

Locally advanced rectal carcinoma, Short-course radiotherapy, Long-course chemoradiotherapy

Abstract

Objective: In locally advanced non-metastatic rectal carcinoma, pre-operative radiotherapy is an acceptable alternative over post-operative radiation to improve locoregional control after radical surgery. There are two regimens of pre-operative radiotherapy – short-course radiotherapy (25 Gy/5 fractions/1 week) and long-course chemoradiotherapy (CRT) (50.4 Gy/28 fractions/5.5 weeks). Our study aimed to compare the pathological response, margin negative surgery rates, and treatment-related acute toxicities between these two approaches.

Methods: Patients with histologically proven locally advanced, non-metastatic rectal adenocarcinoma were randomized into study group and control group – the study group received short-course radiotherapy (25 Gy/5 fractions/1 week) followed by surgery after 7–10 days of completion of radiotherapy and the control group received long-course radiotherapy (50.4 Gy/28 fractions/5.5 weeks) with concurrent capecitabine followed by surgery after 4–6 weeks of completion of radiotherapy. Histopathology reports were studied in both groups for the determination of pathological response of tumor and surgical margin status. All patients received adjuvant chemotherapy for 6 months with oxaliplatin and capecitabine. For the assessment of treatment-related acute toxicities, patients were examined during the entire course of treatment.

Results: Overall pathological response (complete response+partial response) was 81.25% in the study arm and 86.66% in the control arm. Complete response rate was 15% in the study arm and 25% in the control arm. Margin negative surgery rates were higher in long-course CRT than short-course radiotherapy (90% vs. 82%), but it was statistically insignificant. Radiation-induced acute skin reactions (less than Grade 2) were significantly higher in long-course CRT arm (p=0.003).

Conclusion: There is no significant difference between pre-operative short-course radiotherapy and long-course concomitant CRT in terms of efficacy and acute toxicity profile. Thus, with our limited resources and huge patient load, short-course radiotherapy can be used as an acceptable alternative to long-course CRT.

Downloads

Download data is not yet available.

Author Biography

SHYAM SHARMA, Department of Radiotherapy, North Bengal Medical College and Hospital, Darjeeling, West Bengal, India.

Assistant Professor, Department of Radiotherapy, North Bengal Medical College & Hospital, Darjeeling

References

Bray F, Ferlay J, Soerjomataram I, Siegel RL, Torre LA, Jemal A. Global cancer statistics 2018: GLOBOCAN estimates of incidence and mortality worldwide for 36 cancers in 185 countries. CA Cancer J Clin 2018;68:394-424.

Mallath MK, Taylor DG, Badwe RA, Rath GK, Shanta V, Pramesh CS, et al. The growing burden of cancer in India: Epidemiology and social context. Lancet Oncol 2014;15:e205-12.

Enker WE, Thaler HT, Cranor ML, Polyak T. Total mesorectal excision in the operative treatment of carcinoma of the rectum. J Am Coll Surg 1995;181:335-46.

Heald RJ, Husband EM, Ryall RD. The mesorectum in rectal cancer surgery – The clue to pelvic recurrence. Br J Surg 1982;69:613-6.

Heald RJ, Moran BJ, Ryall RD, Sexton R, MacFarlane JK. Rectal cancer: The Basingstoke experience of total mesorectal excision, 1978- 1997. Arch Surg 1998;133:894-9.

MacFarlane JK, Ryall RD, Heald RJ. Mesorectal excision for rectal cancer. Lancet 1993;341:457-60.

Bolognese A, Cardi M, Muttillo IA, Barbarosos A, Bocchetti T, Valabrega S. Total mesorectal excision for surgical treatment of rectal cancer. J Surg Oncol 2000;74:21-3.

Arbman G, Nilsson E, Hallböök O, Sjödahl R. Local recurrence following total mesorectal excision for rectal cancer. Br J Surg 1996;83:375-9.

Ng IO, Luk IS, Yuen ST, Lau PW, Pritchett CJ, Ng M, et al. Surgical lateral clearance in resected rectal carcinomas. A multivariate analysis of clinic pathologic features. Cancer 1993;71:1972-6.

Colorectal Cancer Collaborative Group. Adjuvant radiotherapy for rectal cancer: A systematic overview of 8,507 patients from 22 randomised trials. Lancet 2001;358:1291-304.

Van Gijn W, Marijnen CA, Nagtegaal ID, Kranenbarg EM, Putter H, Wiggers T, et al. Preoperative radiotherapy combined with total mesorectal excision for resectable rectal cancer: 12-year follow-up of the multicentre, randomized controlled TME trial. Lancet Oncol 2011;12:575-82.

Folkesson J, Birgisson H, Pahlman L, Cedermark B, Glimelius B, Gunnarsson U. Swedish Rectal Cancer Trial: Long lasting benefits from radiotherapy on survival and local recurrence rate. J Clin Oncol 2005;23:5644-50.

Bujko K, Nowacki MP, Nasierowska-Guttmejer A, Michalski W, Bebenek M, Kryj M. Long-term results of a randomized trial comparing preoperative short-course radiotherapy with preoperative conventionally fractionated chemoradiation for rectal cancer. Br J Surg 2006;93:1215-23.

Alici S, Aykan NF, Sakar B, Bulutlar G, Kaytan E, Topuz E. Colorectal cancer in young patients: Characteristics and outcome. Tohoku J Exp Med 2003;199:85-93.

Jemal A, Siegel R, Xu J, Ward E. Cancer statistics, 2010. CA Cancer J Clin 2010;60:277-300.

Ngan SY, Burmeister B, Fisher RJ, Solomon M, Goldstein D, Joseph D, et al. Randomized trial of short-course radiotherapy versus long-course chemoradiation comparing rates of local recurrence in patients with T3 rectal cancer: Trans-Tasman radiation oncology group trial 01.04.J Clin Oncol. 2012;30:3827–33.

Erlandsson J, Holm T, Pettersson D, Berglund Å, Cedermark B, Radu C, et al. Optimal fractionation of preoperative radiotherapy and timing of surgery for rectal cancer (Stockholm III): A multi-centre, randomized, non-blinded, phase 3, non-inferiority trial. Lancet Oncol 2017;18:336-46.

Francois Y, Nemoz CJ, Baulieux J, Vignal J, Grandjean JP, Partensky C, et al. Influence of the interval between preoperative radiation therapy and surgery on downstaging and on the rate of sphincter-sparing surgery for rectal cancer: The Lyon R90-01 randomized trial. J Clin Oncol 1999;17:2396.