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Short-course preoperative radiotherapy combined with chemotherapy in resectable locally advanced rectal cancer: local control and quality of life

Radioterapia ipofrazionata short-course neoadiuvante in associazione alla chemioterapia nelle neoplasie rettali operabili in stadio localmente avanzato: controllo locale e qualità di vita

  • Radiotherapy / Radioterapia
  • Published:
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Abstract

Purpose

The authors sought to evaluate the clinical outcome after preoperative short-course radiotherapy (SC-RT) for locally advanced resectable rectal cancer in terms of local control (LC) and quality of life (QoL).

Materials and methods

Patients with locally advanced rectal cancer enrolled between 1997 and 2008 in an observational study of preoperative SC-RT were analysed. The treatment algorithm was neo-adjuvant chemotherapy (CT) administered for four cycles, followed by preoperative SC-RT administered 1 week after chemotherapy completion, delivering 20 Gy in five fractions over 1 week. Immediately in the following week surgery was performed. The adjuvant 5-FU-based CT was planned for pathological stage UICC≥II. LC, overall survival (OS), disease-free survival (DFS), early and late complications (RTOG scale) were analysed. All patients completed the EORTC QoL (C-30 and C-38), Faecal Incontinence QoL, and International Index of Erectile Function questionnaires (IIEF).

Results

A total of 67 patients were analysed. Chemotherapy and radiotherapy were well tolerated. At the pathological analysis, stable disease was obtained in 24 patients (36%), reduction of disease stage in 34 patients (50.7%), and progression in nine cases (13.3%). Adjuvant chemotherapy was indicated in 21 patients. Two locoregional recurrences, both within the radiotherapy volume, were observed, resulting in a 5-year LC of 97%. The 5-year DFS was 84%, with mean time to systemic progression of 24 months. After a mean follow-up of 114 months, the 5-year OS rate was 67%. Late toxicity >grade II was observed in 9% of patients. High anterior resection (AR) patients had significantly better scores than low AR or abdomino-perineal resection (APR). A total of 89% of the patients treated with conservative surgery had regular anal sphincter function. In male patients undergoing AR or APR, erectile dysfunction was found in 47% and 75% of the cases, respectively.

Conclusions

Preoperative SC-RT combined with chemotherapy for locally advanced resectable rectal cancers was well tolerated. This treatment resulted in favourable LC, OS, low rates of toxicity and satisfying QoL.

Riassunto

Obiettivo

Il presente studio si propone di valutare i risultati clinici, in termini di controllo locale di malattia e di qualità di vita, in pazienti affetti da neoplasia rettale operabile in stadio localmente avanzato e sottoposti a un trattamento di radioterapia ipofrazionata short-course neoadiuvante in associazione alla chemioterapia.

Materiali e metodi

Dal 1997 al 2008 i pazienti affetti da neoplasia del retto localmente avanzato sono stati arruolati in uno studio osservazionale di radioterapia ipofrazionata pre-operatoria. L’approccio terapeutico prevedeva un trattamento sistemico neoadiuvante (4 cicli) seguito da radioterapia ipofrazionata short-course per una dose totale di 20 Gy in 5 sedute consecutive erogate in una settimana. Nella settimana successiva al termine del trattamento radiante, tutti i pazienti venivano sottoposti a intervento chirurgico. La chemioterapia adiuvante con 5-FU veniva indicata per gli stadi > II sec. UICC. Per tutti i pazienti in studio sono stati analizzati il controllo locale, la sopravvivenza globale, la sopravvivenza libera da malattia, le complicanze acute e tardive. Inoltre, ciascun paziente ha compilato appositi questionari relativi alla qualità di vita [EORTC QoL (C-30 and C-38), Faecal Incontinence QoL, and International Index of Erectile Function questionnaires (IIEF)].

Risultati

In questo studio sono stati arruolati 67 pazienti. Lo schema terapeutico è stato in generale ben tollerato. All’esame istologico definitivo, una stabilità di malattia è stata ottenuta in 24 pazienti (36%), una riduzione di malattia in 34 pazienti (50,7%) e una progressione in solo 9 casi (13,3%). La chemioterapia adiuvante è stata eseguita in 21 pazienti. Nel corso del follow-up sono state evidenziate due recidive loco-regionali (entrambe in campo di trattamento radioterapico) con un controllo locale a 5 anni del 97%. La sopravvivenza libera da malattia a 5 anni è risultata pari all’84%, con un tempo medio di progressione sistemica di 24 mesi. Dopo un follow-up medio di 114 mesi, il tasso di sopravvivenza globale è risultato pari al 67%. Il 9% dei pazienti ha manifestato una tossicità tardiva di grado superiore al II. In relazione alla qualità di vita, i pazienti sottoposti a chirurgia conservativa hanno collezionato punteggi maggiori ai questionari specifici, riportando nella maggior parte dei casi regolare funzionalità sfinterica anale (89%) e preservazione della funzionalità erettile (75%).

Conclusioni

Il trattamento radioterapico ipofrazionato neoadiuvante associato a chemioterapia nei tumori del retto localmente avanzati risulta essere ben tollerato, con ottimi risultati in termini di controllo locale, sopravvivenza globale e qualità di vita dei pazienti.

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Authors and Affiliations

  1. Radiation Therapy Unit, Department of Oncology and Advanced Technology, Azienda Ospedaliera ASMN, Istituto di Ricovero e Cura a Carattere Scientifico, Viale Risorgimento 80, 42121, Reggio Emilia, Italy

    Patrizia Ciammella, Maria Paola Ruggieri, Maria Galeandro, Nunziata D’Abbiero & Cinzia Iotti

  2. Surgery Department, ASMN, Viale Risorgimento 80, 42121, Reggio Emilia, Italy

    Alessandro Giunta

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  1. Patrizia Ciammella
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  2. Maria Paola Ruggieri
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  3. Maria Galeandro
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  4. Nunziata D’Abbiero
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  5. Alessandro Giunta
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  6. Cinzia Iotti
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Correspondence to Patrizia Ciammella.

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Ciammella, P., Ruggieri, M.P., Galeandro, M. et al. Short-course preoperative radiotherapy combined with chemotherapy in resectable locally advanced rectal cancer: local control and quality of life. Radiol med 118, 1397–1411 (2013). https://doi.org/10.1007/s11547-013-0939-6

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  • DOI: https://doi.org/10.1007/s11547-013-0939-6

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