TY - JOUR
T1 - Pathologic Response and Postoperative Complications After Short-course Radiation Therapy and Chemotherapy for Patients With Rectal Adenocarcinoma
AU - Avila, Santiago
AU - Chang, George J.
AU - Dasari, N. Arvind
AU - Smani, Danyal A.
AU - Das, Prajnan
AU - Herman, Joeseph M.
AU - Koay, Eugene
AU - Koong, Albert
AU - Krishnan, Sunil
AU - Minsky, Bruce D.
AU - Smith, Grace L.
AU - Taniguchi, Cullen
AU - Taggart, Melissa W.
AU - Kaur, Harmeet
AU - Holliday, Emma B.
N1 - Funding Information:
The authors report no relationships or activities directly related to the submitted work. EH receives research funding from Merck & Co. PD receives compensation from Adlai Nortye for serving on an independent advisory panel. AK is a stockholder of a biotechnology company called Aravive Inc. JMH receives compensation for serving as a scientific advisor to Boston Scientific Corp, Bristol-Myers-Squibb, AstraZeneca, Medtronic, and Augmenix Inc. JMH also receives research funding from OncoSil Medical and Galera Therapeutics.This work was supported by Cancer Center Support Grant P30CA016672 from the National Cancer Center, National Institutes of Health to The University of Texas, MD Anderson Cancer Center.
Funding Information:
This work was supported by Cancer Center Support Grant P30CA016672 from the National Cancer Center , National Institutes of Health to The University of Texas, MD Anderson Cancer Center .
Funding Information:
The authors report no relationships or activities directly related to the submitted work. EH receives research funding from Merck & Co. PD receives compensation from Adlai Nortye for serving on an independent advisory panel. AK is a stockholder of a biotechnology company called Aravive Inc. JMH receives compensation for serving as a scientific advisor to Boston Scientific Corp, Bristol-Myers-Squibb, AstraZeneca, Medtronic, and Augmenix Inc. JMH also receives research funding from OncoSil Medical and Galera Therapeutics .
Publisher Copyright:
© 2020 Elsevier Inc.
PY - 2020/6
Y1 - 2020/6
N2 - Background: The role of neoadjuvant short-course radiation therapy (SCRT) in treating rectal adenocarcinoma is a topic of ongoing debate. Growing interest in total neoadjuvant therapy has spurred discussion on the optimal sequence of preoperative SCRT and chemotherapy. Patients and Methods: All patients receiving SCRT (5 Gy × 5 fractions) were identified. Details about preoperative treatments, radiation toxicities, and postoperative complications were collected. Patients were divided into 2 groups: those who underwent surgery within 14 days of completing SCRT and those with a longer delay. Outcomes compared included extent of pathologic response, margin-negative resection rate, acute radiation toxicities, and postoperative complications. Results: Fifty-seven patients with locally advanced or metastatic rectal cancer received SCRT between 2008 and 2018. Thirty-nine of 57 patients underwent definitive pelvic surgery with total mesorectal excision. There were no significant differences in tumor downstaging, radial margin status, or percent tumor viability between patients with immediate surgery versus delayed surgery. The delay group had higher rates of nodal downstaging (64.7% vs. 18.2%; P = .003). There were no differences in total or grade 3+ gastrointestinal radiation toxicity, postoperative complications, reoperation, readmission, and mortality between the 2 groups. Conclusions: Though not yet common in the United States, SCRT has compared favorably with long course chemoradiation in multiple trials. Moreover, it is associated with greater efficiency and less disruption to chemotherapy. Our data show similar response and toxicity outcomes between the immediate and delay groups, suggesting SCRT is well-tolerated regardless of treatment sequence. Recently completed prospective trials may reveal the optimal preoperative treatment sequence.
AB - Background: The role of neoadjuvant short-course radiation therapy (SCRT) in treating rectal adenocarcinoma is a topic of ongoing debate. Growing interest in total neoadjuvant therapy has spurred discussion on the optimal sequence of preoperative SCRT and chemotherapy. Patients and Methods: All patients receiving SCRT (5 Gy × 5 fractions) were identified. Details about preoperative treatments, radiation toxicities, and postoperative complications were collected. Patients were divided into 2 groups: those who underwent surgery within 14 days of completing SCRT and those with a longer delay. Outcomes compared included extent of pathologic response, margin-negative resection rate, acute radiation toxicities, and postoperative complications. Results: Fifty-seven patients with locally advanced or metastatic rectal cancer received SCRT between 2008 and 2018. Thirty-nine of 57 patients underwent definitive pelvic surgery with total mesorectal excision. There were no significant differences in tumor downstaging, radial margin status, or percent tumor viability between patients with immediate surgery versus delayed surgery. The delay group had higher rates of nodal downstaging (64.7% vs. 18.2%; P = .003). There were no differences in total or grade 3+ gastrointestinal radiation toxicity, postoperative complications, reoperation, readmission, and mortality between the 2 groups. Conclusions: Though not yet common in the United States, SCRT has compared favorably with long course chemoradiation in multiple trials. Moreover, it is associated with greater efficiency and less disruption to chemotherapy. Our data show similar response and toxicity outcomes between the immediate and delay groups, suggesting SCRT is well-tolerated regardless of treatment sequence. Recently completed prospective trials may reveal the optimal preoperative treatment sequence.
KW - Gastrointestinal cancers
KW - Radiation toxicity
KW - Total mesorectal excision
KW - Total neoadjuvant therapy
KW - Treatment sequencing
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U2 - 10.1016/j.clcc.2020.02.005
DO - 10.1016/j.clcc.2020.02.005
M3 - Article
C2 - 32173279
AN - SCOPUS:85081637310
VL - 19
SP - 116
EP - 122
JO - Clinical colorectal cancer
JF - Clinical colorectal cancer
SN - 1533-0028
IS - 2
ER -