A Prospective Study on Short Course Radiation Followed by Preoperative Chemotherapy and Delayed Surgery in Carcinoma Rectum ??? A Single Institution Experience from Department of Radiation Oncology, Government Medical College Kottayam

Author(s): Preeya Vasanthakumary1, Anish Kuttappan Soman2, Rema Padanayil Lekshmikutty3, Gargy Anjolian David4

The standard treatment for locally advanced rectal tumours (LARC)-cT3 lesions
with threatened margins, cT4 lesions and node positive lesions is concurrent
chemoradiation followed by surgery or short course radiation followed by
immediate or delayed surgery. Surgery is total mesorectal excision with either low
anterior resection or abdominoperineal resection depending on the location of the
tumour. Radiation reduces local recurrence and improves the overall survival.
Chemotherapy is given to increase tumour regression and decrease perioperative
metastases. Short fractionation schedule of 5 Gy per fraction for 5 days permits
sparing of radiotherapy resources, and saves patients of the morbidity of a
protracted course of radiation of 28 days, with similar oncologic outcome. Further,
the waiting period for surgery improves tumour down staging and pathological
complete response rate.
Patients with cT3 or cT4, fixed, node positive LARC received pelvic radiation 5 × 5
Gy and preoperative chemotherapy with FOLFOX regime followed by surgery.
Of the enrolled 27 patients, the median age of the patient was 57 years (range 40
- 80 years). Acute haematological toxicity was 22 % and G.I. toxicity was 11 %.
Primary endpoint namely pathological complete response (ypCR) was noticed in
22 %. R0 resection rates (secondary end point) was 63 %, down staging rate was
66.7 % and sphincter preservation rate was 37.1 %. Surgery was not done in 25.9
%, of whom two were not willing for surgery, one patient became metastatic and
rest five were deemed inoperable. Acute wound infection was recorded in two
patients (10.2 %) and delayed wound healing (5.2 %) was seen in one patient.
Short-course radiotherapy (RT) induces tumour down staging and sphincter
preservation with acceptable toxicities, when surgery is performed after
chemotherapy at an interval of 6 – 8 weeks for cT3 lesions with threatened
margins, cT4 rectal cancer and N0-2 tumours.