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Short-Course Vs Long-Course Radiotherapy: Pros and Cons

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Current Common Dilemmas in Colorectal Surgery

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Abstract

Neoadjuvant radiotherapy is the standard of care for locally advanced rectal cancer, which can be delivered with short-course (SC) fractionation, 25 Gy in 5 fractions, or in a conventionally fractionated, long-course (LC) schedule over 25–30 fractions with concurrent chemotherapy. The merits of each approach are discussed and appropriate patient selection is recommended. Head-to-head randomized trials have shown little or no significant difference between SC and LC regimens in terms of local control or overall survival; LC results in more pathologic downstaging, but without improvement in sphincter preservation. Both treatment schedules remain viable options depending on the clinical scenario, with SC recommended for expedited treatment and LC when downstaging is needed. Future efforts aim to identify the optimal combination and timing of neoadjuvant radiotherapy and chemotherapy as well as the optimal delay until surgery to maximize response and disease outcomes. Given its shorter course, similar outcomes, and acceptable toxicity profile, SC radiation is likely to become increasingly prevalent as new neoadjuvant regimens are identified.

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Author information

Authors and Affiliations

  1. Department of Radiation Oncology, Stanford Cancer Institute, Stanford, CA, USA

    Nicolas D. Prionas & Daniel T. Chang

  2. Department of Radiation Oncology, MD Anderson Cancer Center, Houston, TX, USA

    Albert C. Koong

Authors
  1. Nicolas D. Prionas
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  2. Albert C. Koong
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  3. Daniel T. Chang
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Correspondence to Daniel T. Chang .

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Editors and Affiliations

  1. London Health Sciences Centre, University Hospital, London, Ontario, Canada

    Christopher M. Schlachta

  2. Mount Sinai School of Medicine, New York, New York, USA

    Patricia Sylla

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Prionas, N.D., Koong, A.C., Chang, D.T. (2018). Short-Course Vs Long-Course Radiotherapy: Pros and Cons. In: Schlachta, C., Sylla, P. (eds) Current Common Dilemmas in Colorectal Surgery. Springer, Cham. https://doi.org/10.1007/978-3-319-70117-2_29

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  • DOI: https://doi.org/10.1007/978-3-319-70117-2_29

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  • Publisher Name: Springer, Cham

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  • Online ISBN: 978-3-319-70117-2

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