Abstract 1627P
Background
Alike other tumor types, it was recommended that the management of locally advanced rectal cancer (LARC) during the COVID outbreak would shift towards hypofractionated RT schemes. Short-course neoadjuvant radiotherapy (SCRT) is comparable to long-course chemoradiation (CRT) in terms of toxicity and survival; nevertheless, CRT is still largely used, especially in advanced tumors. We aim to report the clinical-pathological characteristics and first treatment results of patients treated in a 3-month period during COVID-19 outbreak and to compare them to those treated in the previous year.
Methods
We retrospectively reviewed consecutive cases of patients with LARC treated with neoadjuvant RT during Apr-Jun 2020 and Apr-Jun 2019 (control group). Chi square and independent T tests were used for comparison.
Results
During Apr-Jun 2020, 35 patients (median age 62 [31-86] years, median Charlson score 4 [2-8]) were treated with neoadjuvant RT. Primary tumor was staged as cT2 (6%), cT3 (57% T3a-b, 17% T3c-d) and cT4 (17% T4a, 3% T4b); 83% were cN+; 11% patients were M1 at diagnosis and had primary CT. All patients were treated with SCRT (25Gy/5Gyfr); 20% patients had perioperative CT and 46% had adjuvant CT. In the control group (n=34), 9 patients had SCRT and 25 had CRT (50.4Gy, 1.8Gyfr, plus capecitabine); 6% had primary CT for M1 disease and 6% had perioperative CT. Both groups (2019 vs 2020) were comparable in terms of clinical-pathological variables (age, comorbidities, TNM stage, mesorectal fascia involvement, R0 margin). Pathological complete response (9% vs 11%, p=0.720), modified Ryan tumor regression score ≥2 (74% vs 80%, p=0.456) and rate of postoperative complications ≥III-b (20% vs 9%, p=0.357) also did not differ. Median time from diagnosis to start of RT was 58±43 days vs 61±31 days, p=0.448. Median time to delayed surgery was 66±18 days vs 67±18 days, p=0.948. The start of RT was postponed in 1 patient due to COVID+.
Conclusions
Patient characteristics and time to neoadjuvant RT did not appear to differ during COVID-19 outbreak. A shift towards a safer treatment for LARC during this period did not seem to impact pathological response neither postoperative complications.
Clinical trial identification
Editorial acknowledgement
Legal entity responsible for the study
The authors.
Funding
Has not received any funding.
Disclosure
All authors have declared no conflicts of interest.