The role of hypofractionated preoperative chemoradiotherapy in rectal cancer patients
Taek-Keun Nam,
Korea Republic of
PO-1394
Abstract
The role of hypofractionated preoperative chemoradiotherapy in rectal cancer patients
Authors: Taek-Keun Nam1, Ick Joon Cho1, Jae-Uk Jeong2, Yong-Hyub Kim3, Ju-Young Song4, Sung-Ja Ahn1, Mee Sun Yoon1, Shin Haeng Cho1
1Chonnam National University Medical School, Radiation Oncology, Hwasun-eup, Korea Republic of; 2Chonnam National University Medical School,, Radiation Oncology, Hwasun-eup, Korea Republic of; 3Chonnam National University Medical School, Radiation Oncology, Hwasun-eup, Korea Republic of; 4Chonnam National University Medical School, Radiation oncology, Hwasun-eup, Korea Republic of
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Purpose or Objective
To evaluate the role of hypofractionated preoperative chemoradiotherapy (CRT) with oral capecitabine in rectal cancer patients
Material and Methods
A total of 76 patients with rectal cancer who received surgery after preoperative CRT were analyzed. Number of patients with stage I, II, III, and IVa were 5, 29, 36, and 6, respectively. Distal extent of tumor of ≤ 5 cm from anal verge (AV) and > 5cm were in 31 and 45 patients, respectively. Preoperative CRT was delivered by either schedule such as 35 Gy in 10 fractions to primary tumor simultaneously boosted and 33 Gy to remaining pelvis, or 33 Gy to whole pelvis according to the patient’s performance or tumor stage. Delayed surgery was performed after the completion of CRT. Oral capecitabine was administered at a dose of 1650 mg/m2 /day during radiotherapy concurrently. Tumor response, toxicity, and survival were the study endpoints.
Results
Nine patients (11.8%) achieved pathologically complete response. Sphincter saving was achieved in 23 /31 (74.2%) patients ≤ 5cm from AV and 45 /45 (100%) of >5cm. Of the 76 patients, 29 (38.2%) achieved T-downstaging and 25 (61.0%) had N-downstaging. Follow-up period was ranged 3~71 months (median, 54). In entire patients, 5-year disease-free survival and overall survival were 73.6% and 90.6%, respectively. Six patients had a locoregional failure as a component of failure. Six patients with stage IVa had one or combined salvage treatments out of surgery, chemotherapy, or stereotactic radiotherapy after completion of CRT and all were alive at last follow-up. Three patients experienced grade 3 postoperative complications such as rectovaginal fistula, rectal bleeding, and anastomosis leakage. There was no grade 4 toxicity.
Conclusion
Hypofractionated preoperative CRT of ten fractions showed almost comparable results to historical conventional fractionation. This shorter fractionation scheme could be useful in selected patients with earlier stage located >5cm from AV, simultaneous distant metastasis requiring early intervention, or difficulty of multiple hospital visits.