Short-course Preoperative Radiotherapy with Delayed Surgery for Locally Advanced Rectal Cancer

Abstract

Objectives:To review the outcome of patients with locally advanced rectal cancer who underwent short-course preoperative radiotherapy (SCPRT) with delayed total mesorectal excision. Methods: Consecutive patients with locally advanced rectal cancer who underwent SCPRT with delayed surgery between January 2011 and November 2014 in Tuen Mun Hospital were retrospectively reviewed. Results: Overall, 18 men and five women aged 36 to 88 years underwent SCPRT with delayed surgery owing to advanced age (n = 10), poor performance status (n = 7), and severe comorbidity (n = 6). All patients had at least one risk factor: threatened mesorectal fascia (n = 20), tumour stage 4 (n = 4), lymph node stage 2 (n = 7), and low-lying tumour (n = 5). After SCPRT, 19 of the 23 patients underwent anterior resection (n = 13) or abdominalperianal resection (n = 6) at a median of 11 weeks and achieved R0 (n = 17) or R1 (n = 2) resection. During a median follow-up of 13 months, eight patients died due to metastasis (n = 5), medical condition without evidence of progression (n = 2), or postoperative complications (n = 1). The median survival time of the 23 patients was 34 months. The 1-year overall survival was 75.1%; the 1-year cancer-specific survival was 82.5%; and the 1-year progression-free survival was 79.3%. In 19 patients who underwent resection, six developed metastatic disease. Two patients had local recurrence who also had synchronous distant metastasis. All patients completed SCPRT without interruption. Two patients had grade 3 or above toxicity: one had perforated bowel requiring emergency operation at 3 weeks and another had grade 3 leukopenia without evidence of sepsis. In the postoperative period (≤30 days), eight patients developed surgical complications including anastomotic leakage (n = 2), septic complications (n = 3), persistent perianal infection (n = 1), and ileus (n = 2). One patient died at postoperative day 12 due to myocardial infarction. One patient developed severe late radiotherapy-related toxicity of burst stump and pelvic abscess at 5 months. Conclusion: SCPRT with delayed surgery can downsize and downstage locally advanced rectal cancer and achieve a favourable toxicity profile. It is a viable option for patients who are unfit for preoperative long-course chemoradiotherapy.