Feasibility of Modified Short-Course Radiotherapy Combined With a Chemoradiosensitizer for T3 Rectal Cancer. Issue 5 (May 2015)

• Record Type: Journal Article
• Authors: Beppu, Naohito; Matsubara, Nagahide; Kakuno, Ayako; Doi, Hiroshi; Kamikonya, Norihiko; Yamanaka, Naoki; Yanagi, Hidenori; Tomita, Naohiro
• Is Part Of: Diseases of the colon & rectum. Volume 58:Issue 5(2015:May)
• Publication Date: 2015-05
• Subjects: Colon (Anatomy) -- Diseases -- Periodicals; Rectum -- Diseases -- Periodicals; Colonic Diseases -- Periodicals; Colorectal Surgery -- Periodicals; 616.34
• DOI: 10.1097/DCR.0000000000000323
• Languages: English
• ISSNs: 0012-3706

Abstract

<abstract> <title> <x xml:space="preserve">Abstract</x> </title> <sec> <title>BACKGROUND:</title> <p>5-Fluorouracil-based chemotherapy is considered to be a radiosensitizer; however, conventional short-course radiotherapy combined with chemotherapy is generally thought to not be feasible because of the prevalence of side effects.</p> </sec> <sec> <title>OBJECTIVE:</title> <p>The aim of this study was to evaluate the feasibility of modified short-course radiotherapy combined with a chemoradiosensitizer for T3 rectal cancer.</p> </sec> <sec> <title>DESIGN AND SETTINGS:</title> <p>This study was retrospective in nature and used a prospectively collected database.</p> </sec> <sec> <title>PATIENTS:</title> <p>Patients with T3 rectal cancer located below the peritoneum reflection were selected.</p> </sec> <sec> <title>INTERVENTIONS:</title> <p>A total dose of 25 Gy of radiotherapy was administered in 10 fractions of 2.5 Gy each for 5 days. Radiotherapy was performed with S-1 as a radiosensitizer from day 1 to day 10. Surgery was targeted to be performed 4 weeks after radiotherapy.</p> </sec> <sec> <title>MAIN OUTCOME MEASUREMENTS:</title> <p>The morbidity, sphincter-preserving rate, anal function, and long-term outcomes were assessed.</p> </sec> <sec> <title>RESULTS:</title> <p>All patients (n = 170) completed the radiotherapy regimen and 166 (97.6%) completed the combination regimen with chemotherapy. A total of 149 patients (87.6%) had sphincter-preserving surgery (double stapling technique (DST), 58 patients; intersphincteric resection (ISR), 91 patients), and postoperative complications were relatively mild (anastomotic leakage, 15.4%; intra-abdominal infection, 8.2%). Among those undergoing sphincter preserving surgery, the 5-year local relapse-free survival rate was 94.3% in the DST group, and 89.8% in the ISR group. With respect to the anal function, the Wexner score the first year after stoma closure for the double-stapling technique group was 6 and that for intersphincteric resection was 15; however, the score for the intersphincteric resection group was improved to 8 at 4 years after stoma closure.</p> </sec> <sec> <title>LIMITATIONS:</title> <p>This study had limitations because it was an uncontrolled, 1-arm, retrospective review with a small sample size.</p> </sec> <sec> <title>CONCLUSIONS:</title> <p>Modified short-course radiotherapy combined with chemoradiosensitizer is a feasible approach for treating T3 rectal cancer. With the use of the short-course approach, efforts to reduce the incidence of side effects by appropriately prolonging the waiting period enable the administration of combination treatment with short-course radiotherapy and chemotherapy.</p> </sec> </abstract>