Short-Course Radiation With Delay to Surgery Improves Outcomes in Rectal Cancer

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Patients in whom surgery was delayed after radiotherapy developed fewer complications with equally good outcomes.
Patients in whom surgery was delayed after radiotherapy developed fewer complications with equally good outcomes.

A short course of radiotherapy with a delay prior to surgery may be a useful alternative to conventional short-course radiotherapy with immediate surgery in patients with rectal cancer, a study published in Lancet Oncology has shown.1

A previous study demonstrated that preoperative radiotherapy could reduce the risk of local recurrence by more than 50% for patients with rectal cancer.  Therefore, investigators at the Karolinska Institute in Sweden sought to determine the impact of time to surgery after radiotherapy.

For this study, 840 patients with rectal cancer were randomly assigned to 3 treatment arms. Patients in the first arm underwent standard therapy (short course [5x5 Gy] radiotherapy with direct surgery within 1 week), patients in the second arm underwent short-course (5x5 Gy) radiotherapy followed by delayed surgery in 4 to 8 weeks, and patients in the third arm underwent long-course (25x2 Gy) radiotherapy followed by delayed surgery in 4 to 8 weeks.

Study results showed that patients in whom surgery was delayed developed fewer complications with equally good oncologic outcomes. It also showed that the only difference between long-course and short-course radiotherapy is that the former considerably lengthens the time for treatment.

These findings point toward improved therapeutic strategies, with fewer complications and a sustained low incidence of local recurrence for patients with rectal cancer.

Reference

1. Erlandsson J, Holm T, Pettersson D, et al.  Optimal fractionation of preoperative radiotherapy and timing to surgery for rectal cancer (Stockholm III): a multicentre, randomised, non-blinded, phase 3, non-inferiority trial. Lancet Oncol. 2017 Feb 9. doi: 10.1016/S1470-2045 (17)30086-4 [Epub ahead of print]

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