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

Date 29 September 2014
Event ESMO 2014
Session Poster Display session
Topics Cytotoxic agents
Surgical oncology
Colon and Rectal Cancer
Therapy
Biological therapy
Radiation oncology
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.