P-0284 - Choice of preoperative radiotherapy in treatment of distal T2-3N + /- rectal cancer

Date 28 June 2014
Event World GI 2014
Session Poster Session
Topics Anti-Cancer Agents & Biologic Therapy
Rectal Cancer
Surgery and/or Radiotherapy of Cancer
Presenter Ighor Shchepotin
Citation Annals of Oncology (2014) 25 (suppl_2): ii14-ii104. 10.1093/annonc/mdu165
Authors V. Ivankova, O. Grabovoy, O. Stolyarova
  • National cancer institute, Kyiv/UA

Abstract

Introduction

The two broad approaches to preoperative 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 × 5 Gy) and surgery within 1-2 days (Group 1) or long-course radiotherapy (30 Gy in 15 fractions of 2 Gy) and surgery 4 weeks later (Group 2). The median follow-up of living patients was 48 (range 38–64) months.

Results

Complete response - 8,8%, partial response - 42,3% in Group 2. The actuarial 5-year overall survival was 77.6% in the Group 1 and 90,2% in the Group 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%).

Conclusion

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