Rectal cancer: optimal dose, surgical timing with neoadjuvant radiotherapy

  • Radiother Oncol

  • curated by Emily Willingham, PhD
  • Univadis Clinical Summaries
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Takeaway

  • For rectal cancer, neoadjuvant radiotherapy (RT) at 5×5 Gy with surgery delayed to 4-8 weeks yields greater tumor regression compared with 25×2 Gy and/or shorter time to surgery.

Why this matters

  • The best fractionation regimen and timing to surgery in the use of neoadjuvant radiotherapy for rectal cancer have not been established.
  • These data are from the Stockholm III trial.

Study design

  • Patients (n=840) were randomly allocated to:
    • RT 5×5 Gy with surgery within 1 week (short-course RT [SRT]).
    • 5×5 Gy with surgery after 4-8 weeks (SRT-delay).
    • 2 Gy×25 with surgery after 4-8 weeks (long-course RT [LRT]-delay).
  • Median follow-up, 5.7 years.
  • This analysis focused on the correlation between tumor regression and OS.
  • Funding: Swedish government, others.

Key results

  • Pathological complete response (pCR):
    • SRT: 0.3%
    • SRT-delay: 10.4%
    • LRT-delay: 2.2%.
  • With pCR vs non-pCR: 
    • OS: HR, 0.51 (P=.046). 
    • Time to recurrence: HR, 0.27 (P=.027).

Limitations

  • 13% had missing pathology or nonevaluable slides.
  • Long recruitment period could mean some changes in accuracy of preoperative staging.

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