Preoperative radiotherapy and local excision of rectal cancer: Long-term results of a randomised study

Publication date: June 2018
Source:Radiotherapy and Oncology, Volume 127, Issue 3
Author(s): Przemysław Wawok, Wojciech Polkowski, Piotr Richter, Marek Szczepkowski, Janusz Olędzki, Ryszard Wierzbicki, Tomasz Gach, Andrzej Rutkowski, Adam Dziki, Leszek Kołodziejski, Rafał Sopyło, Lucyna Pietrzak, Jacek Kryński, Katarzyna Wiśniowska, Mateusz Spałek, Konrad Pawlewicz, Marcin Polkowski, Teresa Kowalska, Krzysztof Paprota, Małgorzata Jankiewicz, Andrzej Radkowski, Justyna Chalubińska-Fendler, Wojciech Michalski, Krzysztof Bujko
Background and purposeIt is uncertain whether local control is acceptable after preoperative radiotherapy and local excision (LE). An optimal preoperative dose/fractionation schedule has not yet been established.Material and methodsIn a phase III study, patients with cT1-2N0M0 or borderline cT2/T3N0M0 < 4 cm rectal adenocarcinomas were randomised to receive either 5 × 5 Gy plus 1 × 4 Gy boost or chemoradiation: 50.4 Gy in 28 fractions plus 3 × 1.8 Gy boost and 5-fluorouracil with leucovorin bolus. LE was performed 6–8 weeks later. Patients with ypT0–1R0 disease were observed. Completion total mesorectal excision (CTME) was recommended for poor responders, i.e. ypT1R1/ypT2-3.ResultsOf 61 randomised patients, 10 were excluded leaving 51 for analysis; 29 in the short-course group and 22 in the chemoradiation group. YpT0–1R0 was observed in 66% of patients in the short-course group and in 86% in the chemoradiation group, p = 0.11. CTME was performed only in 46% of patients with ypT1R1/ypT2-3. The median follow-up was 8.7 years. Local recurrence incidences and overall survival at 10 years were respectively for the short-course group vs. the chemoradiation group 35% vs. 5%, p = 0.036 and 47% vs. 86%, p = 0.009. In total, local recurrence at 10 years was 79% for ypT1R1/T2-3 without CTME.ConclusionsThis trial suggests that in the LE setting, both local recurrence and survival are worse after short-course radiotherapy than after chemoradiation. Because of the risk of bias, a confirmatory study is desirable. Lack of CTME is associated with an unacceptably high local recurrence rate.



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