Downstaging in Advanced Rectal Cancers: A Propensity-Matched Comparison Between Short-Course Radiotherapy Followed by Chemotherapy and Long-Course Chemoradiotherapy

Abstract

BACKGROUND: Short-course radiotherapy followed by chemotherapy has not been widely evaluated as an alternative to traditional long-course chemoradiotherapy in locally advanced rectal cancer. OBJECTIVE:This study compared the oncological and short-term outcomes between short-course radiotherapy + chemotherapy and long-course chemoradiotherapy in locally advanced rectal cancer.DESIGN: This is a retrospective propensity-matched study SETTINGS:The study was conducted in a colorectal department at a tertiary care oncology center in India.PATIENTS: There were 173 patients. Group A had 47 patients and group B had 126 patients. A 1:2.7 matching was done for age, sex, distance of tumor from the anal verge, sphincter preservation surgeries, MRI-based pretreatment T stage, and circumferential resection margin. INTERVENTIONS:The interventions performed were short-course radiotherapy + chemotherapy (group A) and long-course chemoradiotherapy (group B) in locally advanced rectal cancer. MAIN OUTCOME MEASURES:The primary measures were pathological circumferential resection margin positivity, downstaging, tumor regression grade, and postoperative complications. RESULTS: Of the patients, 52% had a positive circumferential resection margin on MRI, 57% had low rectal tumors, and 20% had T4 tumors. Distribution of rectal surgeries was similar between the 2 groups. pT downstaging and tumor regression scores were significantly better in group B (p = 0.028 and 0.026). Pathological circumferential resection margin, distal resection margin, and nodal yield were similar. On multivariate analysis, pretreatment N status was the only independent predictive factor for pathological circumferential resection margin status. Grade 3 to 4 Clavien-Dindo complications, anastomotic leak rates, and hospital stay were similar between the 2 groups. LIMITATIONS: This was a retrospective study. Although propensity matching was performed, selection bias cannot be eliminated completely, as seen in the difference in the surgical approaches between the 2 groups. CONCLUSIONS: In a cohort containing a significant portion of MRI circumferential resection marginpositive low rectal cancers, short-course radiotherapy + chemotherapy followed by delayed surgery resulted

Bowel Functional Outcomes After Long-Course or Short-Course Radiation for Advanced Rectal Cancers: A Propensity-Matched Analysis

“…The median duration between ostomy reversal and functional assessment was similar in both groups (24 months in LCRT vs 22 months in SCRT). The median Wexner scores were 6 (range, [4][5][6][7][8][9][10][11][12][13][14][15] in the LCRT group and 7 (range, [4][5][6][7][8][9][10][11][12][13][14] in the SCRT group (Table 2). No difference in the proportion of major incontinence was detected between the groups (8.1% in LCRT ) after SCRT (p < 0.001).…”

“…4 Overall, downstaging seems to be superior with SCRT and chemotherapy based on pathological complete responses; however, the oncological superiority over LCRT is yet to be established. 3,5,6…”

“…4 Overall, downstaging seems to be superior with SCRT and chemotherapy based on pathological complete responses; however, the oncological superiority over LCRT is yet to be established. 3,5,6 What matters in cancer therapeutics is either an increase in OS or quality of life (QOL) for a treatment to be justified. Because the OS benefit is uncertain, the functional aspects should be investigated.…”

Quality of life and clinical outcomes in rectal cancer patients treated on a 1.5T MR-Linac within the MOMENTUM study

“…Studies have demonstrated the benefit of SCRT for the reduction of local recurrence rates and improving long-term outcomes as compared to surgery alone [26] , [27] . Other studies showed that SCRT results in tumor downstaging and in some cases even in a clinical or pathological complete response after delayed surgery [9] , [12] , [28] , [29] . This has expanded the eligibility for organ-preserving treatment, aiming to maintain rectal function while effectively treating the cancer, enhancing a better QoL [30] , [31] .…”

Contemporary results from the PelvEx collaborative: improvements in surgical outcomes for locally advanced and recurrent rectal cancer

“…It should be noted that surgical advances have been complemented by improvements in neoadjuvant treatments. Most recently, the use of total neoadjuvant therapy has become the standard of care in LARC [17][18][19][20][21], while early data on the use of immunotherapy has produced promising results [22]. However, the optimal management approach in LRRC remains unclear and varies substantially between regions [23,24].…”