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Comparison of preoperative short-course radiotherapy and long-course radiochemotherapy for locally advanced rectal cancer

Vergleich von präoperativer Kurzzeitstrahlentherapie und Langzeitradiochemotherapie beim lokal fortgeschrittenen Rektumkarzinom

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Abstract

Background

The purpose of this work was to perform a single institution comparison between preoperative short-course radiotherapy (SC-RT) and long-course radiochemotherapy (LC-RCHT) for locally advanced rectal cancer.

Methods

A total of 225 patients with clinical stage UICC II–III rectal cancer were treated with SC-RT (29 Gy in 10 twice daily fractions followed by immediate surgery; n = 108) or LC-RCHT (54 Gy in 28 fractions with simultaneous 5-fluorouracil (5-FU) ± oxaliplatin chemotherapy followed by delayed surgery; n = 117). All patients in the LC-RCHT cohort and patients in the SC-RT with pathological UICC stage ≥ II received adjuvant chemotherapy. Before 2004, the standard of care was SC-RT with LC-RCHT reserved for patients where downstaging was considered as required for sphincter preservation or curative resection. In the later period, SC-RT was practiced only for patients unfit for radiochemotherapy.

Results

Patients in the LC-RCHT cohort had a significantly higher proportion of cT4 tumors, clinical node positivity, and lower tumor location. The 5-year local control (LC) and overall survival (OS) were 91% and 66% without differences between the SC-RT and LC-RCHT groups. Acute toxicity was increased during LC-RCHT (grade ≥ II 1% vs. 33%) and there were no differences in postoperative complications. Severe late toxicity grade ≥ III was increased after SC-RT (12% vs. 3%). Of patients aged >  80 years, 7 of 7 patients and 4 of 9 patients received curative surgery after SC-RT and LC-RCHT, respectively.

Conclusion

Despite the fact that patients with worse prognostic factors were treated with LC-RCHT, there were no significant differences in LC and OS between the SC-RT and LC-RCHT group. Age > 80 years was identified as a significant risk factor for LC-RCHT and these patients could be treated preferably with SC-RT.

Zusammenfassung

Hintergrund

Ziel der Arbeit war der monozentrische Vergleich von präoperativer Kurzzeitbestrahlung (KZ-RT) mit Langzeitradiochemotherapie (LZ-RCHT) beim lokal fortgeschrittenen Rektumkarzinom.

Methoden

Insgesamt 225 Patienten im klinischen Stadium II–III wurden mit KZ-RT (2-mal tägl. Bestrahlung mit 10 -mal  2,9 Gy innerhalb einer Woche und sofortige Operation; n = 108) oder LZ-RCHT (28 -mal 1,8 Gy mit 5-FU ± Oxaliplatin-Chemotherapie und verzögerte Operation; n = 117) behandelt. Alle Patienten in der LZ-RCHT-Kohorte und Patienten in der KZ-RT-Kohorte im pathologischen UICC-Stadium ≥ II wurden adjuvant chemotherapiert. Bis 2004 war die KZ-RT die Standardbehandlung, außer wenn ein Downstaging zum Sphinktererhalt oder zur kurativen Resektabilität als notwendig erachtet wurde. Ab 2004 wurde die KZ-RT lediglich bei Patienten durchgeführt, deren Allgemeinzustand eine RCHT nicht erlaubte.

Ergebnisse

Patienten in der LZ-RCHT-Kohorte hatten einen höheren Anteil an cT4-Tumoren, klinisch befallene Lymphknoten und tiefe Tumorlokalisation. Die lokale Tumorkontrolle (LC) betrug 91% nach 5 Jahren und das Gesamtüberleben (OS) war 66%, jeweils ohne Unterschiede zwischen KZ-RT und LZ-RCHT. Akute Nebenwirkungen waren häufiger während LZ-RCHT (Grad ≥ II 1% vs. 33%), postoperative Komplikationen waren nicht verschieden. Schwere späte Nebenwirkungen ≥ Grad III waren häufiger nach KZ-RT (12% vs. 3%) 7/7 bzw. 4/9 Patienten im Alter >  80 Jahren konnten nach KZ-RT bzw. LZ-RCHT einer kurativen Resektion zugeführt werden.

Schlussfolgerung

Obwohl die Kohorte, die mit LZ-RCHT behandelt wurde, vermehrte Risikofaktoren auswies, konnte kein Unterscheid zwischen KZ-RT und LZ-RCHT bezüglich LC und OS gefunden werden. Ein Alter von > 80 Jahren konnte als Risikofaktor bei LZ-RCHT identifiziert werden. Diese Patienten könnten daher bevorzugt mit KZ-RT behandelt werden.

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Conflict of interest

On behalf of all authors, the corresponding author states that there are no conflicts of interest.

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Authors and Affiliations

  1. Klinik und Poliklinik für Strahlentherapie, Universitätsklinikum Würzburg, Josef-Schneider-Str. 11, 97080, Würzburg, Germany

    M. Guckenberger, G. Saur, D. Wehner, R.A. Sweeney & M. Flentje

  2. Chirurgische Klinik I, Universitätsklinikum Würzburg, Würzburg, Germany

    A. Thalheimer & C.-T. Germer

Authors
  1. M. Guckenberger
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  2. G. Saur
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  3. D. Wehner
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  4. R.A. Sweeney
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  5. A. Thalheimer
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  6. C.-T. Germer
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  7. M. Flentje
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Correspondence to M. Guckenberger.

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Guckenberger, M., Saur, G., Wehner, D. et al. Comparison of preoperative short-course radiotherapy and long-course radiochemotherapy for locally advanced rectal cancer. Strahlenther Onkol 188, 551–557 (2012). https://doi.org/10.1007/s00066-012-0131-2

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  • DOI: https://doi.org/10.1007/s00066-012-0131-2

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