Short-course preoperative radiotherapy combined with delayed surgery reduces the adverse effects of rectal cancer surgery while maintaining its efficiency, according to a study published in The Lancet (published online February 9, 2017; doi: 10.1016/S1470-2045(17)30086-4).
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Preoperative radiotherapy has clinically shown to improve prognoses and reduce risk of local recurrence for people with rectal cancer. However, the optimal radiotherapy dosage and interval between preoperative radiotherapy and surgery is a topic for debate.
Anna Martling, PhD, senior consultant surgeon, department of molecular medicine and surgery, Karolinska Institute (Sweden), and colleagues conducted a study to investigate rectal cancer local recurrence in patients randomized between three different radiotherapy regimens: standard short-course (5x5 Gy) radiotherapy with direct surgery within a week, short-course (5x5 Gy) radiotherapy followed by surgery after 4-8 weeks, and long-course (25x2 Gy) radiotherapy followed by surgery after 4-8 weeks. A total of 385 patients were sampled in a three-arm randomization – 129 patients in the short-course radiotherapy group, 128 patients in the short-course radiotherapy with delay group, and 128 patients in the long-course radiotherapy with delay. A separate two-arm randomization featured 228 patients undergoing short-course radiotherapy with direct surgery within a week and 277 patients undergoing short-course radiotherapy with delayed surgery. The primary endpoint was time to local recurrence, measured from the date of randomization to the date of recurrence.
Results of the study showed that for patients with any local recurrence, median time to local recurrence was 33.4 months (18.2-62.2) in the short-course radiotherapy group, 19.3 months (8.5-39.5) in the short-course radiotherapy with delay group, and 33.3 months (17.8-114.3) in the long-course radiotherapy with delay group. Frequency of postoperative complications was similar between all arms in the three-arm analysis, but risk of postoperative complications was significantly lower after short-course radiotherapy with delay compared with after short-course radiotherapy with immediate surgery (53% of patients vs 41% of patients, respectively; odds ratio 0.61, 95% CI, 0.45-0.83, P = 0.001).
Researchers concluded that patients with delayed surgery after postoperative radiotherapy develop fewer complications with equally good oncological outcomes. Additionally, no benefit is received from undergoing long-course radiotherapy compared with short-course radiotherapy.
“The results of the study will give rise to improved therapeutic strategies, fewer complications with a sustained low incidence of local recurrence, and better survival rates for rectal cancer patients,” said Dr Martling in an interview (SatPRNews, February 10, 2017). “The results can now be immediately put to clinical use to the considerable benefit of the patients.”
