614P - Neoadjuvant treatment in rectal cancer: long- vs short-course radiotherapy

Date 01 October 2012
Event ESMO Congress 2012
Session Poster presentation III
Topics Rectal Cancer
Surgery and/or Radiotherapy of Cancer
Presenter João Casalta-Lopes
Authors J. Casalta-Lopes1, I. Nobre-Góis2, T. Teixeira2, M. Borrego2, P. Soares2, A. Sa3
  • 1Radiation Oncology, CHUC, 3000-075 - Coimbra/PT
  • 2Radiation Oncology, CHUC, Coimbra/PT
  • 3Medical Oncology, CHUC, Coimbra/PT

Abstract

Introduction

Two schemes for pre-operative radiotherapy (RT) in locally advanced rectal carcinoma (RC) are possible: long-course irradiation (45 – 50.4 Gy / 25 – 28 fr) with chemotherapy (CHT), followed by surgery after 6 to 8 weeks; and short-course irradiation (25 Gy / 5 fr), followed by surgery usually 1 week after. Some studies have shown a downstaging effect with delayed surgery in short-course irradiation Goal: Compare results of different irradiation schemes for neoadjuvant treatment of RC in a Radiation Oncology Department.

Methods

Patients with RC treated pre-operatively between 2002 and 2012 were included. RT was performed according to 2 schemes: long-course scheme (GROUP 1) using only RT (GROUP 1A), with oral CHT (GROUP 1B) or infusion CHT (GROUP 1C); and short-course scheme (GROUP 2).

Results

265 patients were included, 227 in GROUP 1. GROUP 1A were older than GROUP 1B and 1C (p < 0.001). Grade 3 and 4 toxicity was only observed in the groups treated with concomitant CHT. Median time to surgery was 7 weeks. Response to treatment was statistically different regarding node downstaging (58.3% vs 77.1% vs 55.8%; p = 0.015) and locoregional response (56.3 vs 82.6% vs 70.5%; p = 0.020). GROUP 2 patients were older than those from GROUP 1 (p < 0.001), had lower Karnofsky index (p = 0.004) and several comorbidities. 15.8% patients (vs 0%) were considered M1 and more tumours were further than 5 cm from the anal margin in GROUP 2 (68.4% vs 49.8%; p = 0.033). No acute toxicity was observed in GROUP 2 and median time to surgery was 2 weeks, with 65.7% of locoregional response. Considering time to surgery (≤1 week vs >1 week) there were significant differences in locoregional response (28.6% vs 75.0%, p = 0.033), with 2 complete responses in those with greater time to surgery.

Conclusions

These results are according to literature: long-course scheme with concomitant CHT provided better locoregional response, although with some acute toxicity; a higher time to surgery in short-course scheme appears to have better results, with no increase in surgical complications. Short-course irradiation with surgery delay appears to be a useful alternative to long-course radiochemotherapy, namely in patients with advanced age and associated comorbidities.

Disclosure

All authors have declared no conflicts of interest.