581P - Neoadjuvant treatment of rectal cancer: Short-course vs long-course radiotherapy?

Date 29 September 2014
Event ESMO 2014
Session Poster Display session
Topics Anti-Cancer Agents & Biologic Therapy
Rectal Cancer
Surgery and/or Radiotherapy of Cancer
Presenter Igor Shchepotin
Citation Annals of Oncology (2014) 25 (suppl_4): iv167-iv209. 10.1093/annonc/mdu333
Authors I. Shchepotin, O.O. Kolesnik, V.I. Ivankova, O.Y. Stolyarova, A.P. Beznosenko, D. Mahmudov, V.V. Zvirich
  • Abdominal, National cancer institute, 03022 - Kyiv/UA

Abstract

Aim

The two broad approaches to neoadjuvant therapy for distal rectal cancer - short-course and long-course radiation. The outcomes of these approaches reported in nonrandomized trials are not comparable because patients selected for treatment with short-course radiotherapy included those with T1–3 disease. The aim of this study was to compare survival, local control, postoperative complications and anal sphincter preservation in the two treatment groups: short-course (sRT) versus long-course radiotherapy (lRT) as a neoadjuvant modality for the management of lower rectal cancer.

Methods

The study randomized 172 patients with T2-3N + /-M0 distal rectal cancer. Patients receive either neoadjuvant short-course radiotherapy (5 x 5 Gy ) and surgery within 1-2 days (Groupe 1) or long-course radiotherapy (30 Gy in 15 fractions of 2 Gy) and surgery 4 weeks later (Groupe 2). The median follow-up of living patients was 48 (range 38–64) months.

Results

Complete response - 8,8%, partial response - 42,3% in Groupe 2. The actuarial 5-year overall survival was 77.6 % in the Groupe 1 and 90,2 % in the Groupe 2 (P = 0,01). Disease-free survival was 62,7% versus 86,4 per cent (P = 0,001), crude incidence of local recurrence was 8,8% versus 6,9% (P = 0.170) respectively. Anal sphincter preservation in Group 2 was 91,1%, compared with 55,4% in the 1st group. Number of sphincter saving surgery for patients in Group 2 with initially planned abdominoperineal resection of the rectum increased by 2.7 times (p <0,005). Postoperative complications such as anastomotic leak comparable in both groups (8.8 and 7.5%).

Conclusions

Combined treatment of patients with distal rectal cancer (T2-3N + /-M0) using neoadjuvant long-course radiotherapy of 30 Gy is safe and effective.

Disclosure

All authors have declared no conflicts of interest.