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Abstract
Background/aim: We aimed to compare the clinicopathological outcomes in patients with locally advanced rectal cancer after short- or long-course concurrent chemoradiotherapy (CCRT) followed by delayed surgery.

Patients and methods: The records of 94 patients with cT3-4N0-2M0 rectal cancer who received CCRT between 2010 and 2017 were reviewed. Short-course radiotherapy (RT) was delivered with a median total dose of 25 Gy in five fractions (n=27), and long-course RT was delivered with a median total dose of 50.4 Gy in 28 fractions (n=67). The following concurrent chemotherapy regimens were administered: 5-fluorouracil plus leucovorin in 58 and capecitabine in 24; in 12 cases agents were unknown. The median interval between CCRT and surgery was 8 weeks. Adjuvant chemotherapy was administered after surgery in 80 patients (5-fluorouracil plus leucovorin, n=54; capecitabine, n=9; other, n=14; and unknown, n=3). Propensity-score matching analysis was conducted.

Results: The median follow-up duration was 4.3 years. There were no statistically significant differences between the short- and long-course RT groups in sphincter preservation (85.2% vs. 92.5%, p=0.478), pathological complete remission (18.5% vs. 14.9%, p=0.905), downstaging (44.4% vs. 26.9%, p=0.159), and negative circumferential resection margin (92.6% vs. 89.6%, p=0.947) rates. No differences were found in survival outcomes between the short- and long-course groups at 3 years (overall survival: 91.8% vs. 88.1%, p=0.790; disease-free survival, 75.2% vs. 72.5%, p=0.420; locoregional relapse-free survival, 90.5% vs. 98.4%, p=0.180; and distant metastasis-free survival, 79.6% vs. 73.5%, p=0.490). Similar results were observed after PSM.

Conclusion: Clinically, short-course CCRT may be a feasible alternative to long-course CCRT in patients with locally advanced rectal cancer.

Affiliations

Jae Sik Kim 1 2, Mi Joo Chung 3, Doo Yeul Lee 1, Suk Hwan Lee 4, Seung-Kyu Jeong 5, Byung Eun Yoo 6, Choon Sik Chung 7, Weon Kuu Chung 8
1Department of Radiation Oncology, Kyung Hee University Hospital at Gangdong, Seoul, Republic of Korea.
2Department of Radiation Oncology, Soonchunhyang University Seoul Hospital, Soonchunhyang University College of Medicine, Seoul, Republic of Korea.
3Department of Radiation Oncology, Hanyang University Changwon Hanmaeum Hospital, Changwon, Republic of Korea.
4Department of Surgery, Kyung Hee University Hospital at Gangdong, Seoul, Republic of Korea.
5Department of Surgery, Yang Hospital, Seoul, Republic of Korea.
6Department of Surgery, Yang Hospital, Namyangju, Republic of Korea.
7Department of Surgery, Hansol Hospital, Seoul, Republic of Korea.
8Department of Radiation Oncology, Kyung Hee University Hospital at Gangdong, Seoul, Republic of Korea; wkchung16@gmail.com.