What Are the Present Recommendations for Short-Course Preoperative Radiotherapy (RT) and Delayed Surgery?
Short-course radiotherapy (RT) to 5 × 5 Gy with immediate surgery is an established treatment to lower local failure rates in many patients with primary rectal cancer. If surgery is delayed for 4–8 weeks, downstaging/downsizing is frequently seen and a pathological complete remission is seen in 10–15% of the patients. Previously non-resectable tumors have then frequently become resectable with long-term cure in a proportion of the patients. It has very low acute (and late) toxicity and is an alternative in elderly patients if comorbidity prevents chemoradiotherapy (CRT). It has been explored in randomized trials also in younger and fit patients and may become an alternative to short-course with immediate surgery and to CRT, both because of less acute toxicity and convenience with similar efficacy. The latter remains to be established.
KeywordsDelayed surgery Downsizing Downstaging Rectal cancer Short-course radiotherapy
- 1.Sebag-Montefiore D, Stephens RJ, Steele R, Monson J, Grieve R, Khanna S et al (2009) Preoperative radiotherapy versus selective postoperative chemoradiotherapy in patients with rectal cancer (MRC CR07 and NCIC-CTG C016): a multicentre, randomised trial. Lancet 373:811–820CrossRefPubMedPubMedCentralGoogle Scholar
- 6.Hatfield P, Hingorani M, Radhakrishna G, Cooper R, Melcher A, Crellin A et al (2009) Short-course radiotherapy, with elective delay prior to surgery, in patients with unresectable rectal cancer who have poor performance status or significant co-morbidity. Radiother Oncol 92:210–214CrossRefPubMedGoogle Scholar
- 11.Latkauskas T, Pauzas H, Gineikiene I, Janciauskiene R, Juozaityte E, Saladzinskas Z et al (2012) Initial results of a randomized controlled trial comparing clinical and pathological downstaging of rectal cancer after preoperative short-course radiotherapy or long-term chemoradiotherapy, both with delayed surgery. Color Dis 14:294–298CrossRefGoogle Scholar
- 13.van Dijk TH, Tamas K, Beukema JC, Beets GL, Gelderblom AJ, de Jong KP et al (2013) Evaluation of short-course radiotherapy followed by neoadjuvant bevacizumab, capecitabine, and oxaliplatin and subsequent radical surgical treatment in primary stage IV rectal cancer. Ann Oncol 24:1762–1769CrossRefPubMedGoogle Scholar
- 18.Bujko K, Nowacki MP, Nasierowska-Guttmejer A, Michalski W, Bebenek M, Kryj M et al (2006) Long-term results of a randomised trial comparing preoperative short-course radiotherapy vs preoperative conventionally fractionated chemoradiation for rectal cancer. Br J Surg. 93:1215–1223CrossRefPubMedGoogle Scholar
- 19.Ngan SY, Burmeister B, Fisher RJ, Solomon M, Goldstein D, Joseph D et al (2012) Randomized trial of short-course radiotherapy versus long-course chemoradiation comparing rates of local recurrence in patients with t3 rectal cancer: trans-tasman radiation oncology group trial 01.04. J Clin Oncol 30:3827–3833CrossRefPubMedGoogle Scholar
- 20.Zhou ZR, Liu SX, Zhang TS, Chen LX, Xia J, Hu ZD et al (2014) Short-course preoperative radiotherapy with immediate surgery versus long-course chemoradiation with delayed surgery in the treatment of rectal cancer: a systematic review and meta-analysis. Surg Oncol 23:211–221CrossRefPubMedGoogle Scholar