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. 2024 Jan 23:18:42-49.
doi: 10.1016/j.sopen.2024.01.015. eCollection 2024 Mar.

Surgical and local control outcomes after sequential short-course radiation therapy and chemotherapy for rectal cancer

I-Chia Liu  1 , Susan Gearhart  2 , Suqi Ke  3 , Chen Hu  3 , Haniee Chung  2 , Jonathan Efron  2 , Alodia Gabre-Kidan  2 , Peter Najjar  2 , Chady Atallah  4 , Bashar Safar  4 , Eric S Christenson  5 , Nilofer S Azad  5 , Valerie Lee  5 , Atif Zaheer  6 , Jacqueline E Birkness-Gartman  7 , Abhinav V Reddy  1 , Amol K Narang  1 , Jeffrey Meyer  1
Affiliations

Surgical and local control outcomes after sequential short-course radiation therapy and chemotherapy for rectal cancer

I-Chia Liu et al. Surg Open Sci. .

Abstract

Background: Total neoadjuvant therapy (TNT) is an accepted approach for the management of locally advanced rectal cancer (LARC) and is associated with a decreased risk of development of metastatic disease compared to standard neoadjuvant therapy. However, questions remain regarding surgical outcomes and local control in patients who proceed to surgery, particularly when radiation is given first in the neoadjuvant sequence. We report on our institution's experience with patients who underwent short-course radiation therapy, consolidation chemotherapy, and surgery.

Methods: We retrospectively reviewed surgical specimen outcomes, postoperative complications, and local/pelvic control in a large cohort of patients with LARC who underwent neoadjuvant therapy incorporating upfront short-course radiation therapy followed by consolidation chemotherapy.

Results: In our cohort of 83 patients who proceeded to surgery, a complete/near-complete mesorectal specimen was achieved in 90 % of patients. This outcome was not associated with the time interval from completion of radiation to surgery. Postoperative complications were acceptably low. Local control at two years was 93.4 % for all patients- 97.6 % for those with low-risk disease and 90.4 % for high-risk disease.

Conclusion: Upfront short-course radiation therapy and consolidation chemotherapy is an effective treatment course. Extended interval from completion of short-course radiation therapy did not impact surgical specimen quality.

Keywords: Proctectomy; Radiation therapy; Rectal cancer.

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Conflict of interest statement

Authors ICL, SG, SK, CH, HC, JE, AGK, PAN, CA, BS, VL, AZ, JEBG, AVR, and AKN have no conflicts of interest to declare. ESC reports grants from Haystack, Pfizer, Affirmed, and NextCure and honoraria/speaking fees from Seres Therapeutics. NSA reports receiving institutional funding from Agios, Inc., Array, Atlas, Bayer HealthCare, BMS, Celgene, Debio, Eli Lilly and Company, EMD Serono, Incyte Corporation, Intensity, Merck & Co., Inc. and Taiho Pharmaceuticals Co., Ltd., being a paid consultant for Mirati and QED, and participating on advisory board for Incyte, QED, and Glaxo Smith Kline. JM reports receiving royalty from UpToDate and Springer and sponsored research support from Boston Scientific.

Figures

Fig. 1
Fig. 1
Treatment pathway at our institution.
Fig. 2
Fig. 2
Freedom from local failure Kaplan-Meier curve.
See this image and copyright information in PMC

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