Short course radiotherapy and delayed surgery for locally advanced rectal cancer in frail patients: is it a valid option?
Abscess
/ epidemiology
Adenocarcinoma
/ complications
Aged
Aged, 80 and over
Cancer Pain
/ etiology
Colectomy
Digestive System Fistula
/ epidemiology
Disease-Free Survival
Female
Frailty
/ complications
Humans
Male
Middle Aged
Neoadjuvant Therapy
/ methods
Neoplasm Staging
Postoperative Complications
/ epidemiology
Proctectomy
/ methods
Radiotherapy, Conformal
/ methods
Rectal Neoplasms
/ complications
Retrospective Studies
Surgical Wound Infection
/ epidemiology
Survival Rate
Elderly patient
Frail patient
Locally advanced rectal cancer
Neoadjuvant chemoradiotherapy
Older patient
Short course radiotherapy
Journal
European journal of surgical oncology : the journal of the European Society of Surgical Oncology and the British Association of Surgical Oncology
ISSN: 1532-2157
Titre abrégé: Eur J Surg Oncol
Pays: England
ID NLM: 8504356
Informations de publication
Date de publication:
08 2021
08 2021
Historique:
received:
22
09
2020
revised:
28
11
2020
accepted:
06
03
2021
pubmed:
25
3
2021
medline:
15
12
2021
entrez:
24
3
2021
Statut:
ppublish
Résumé
The endpoint of the present study was to evaluate the outcomes of short-course radiotherapy (SCRT) and SCRT with delayed surgery (SCRT-DS) on a selected subgroup of frail patients with locally advanced middle/low rectal adenocarcinoma. From January 2008 to December 2018, a total of 128 frail patients with locally advanced middle-low rectal adenocarcinoma underwent SCRT and subsequent restaging for eventual delayed surgery. Rates of complete pathological response, down-staging, disease free survival (DFS) and overall survival (OS) were analyzed. 128 patients completed 5 × 5 Gy pelvic radiotherapy. 69 of these were unfit for surgery; 59 underwent surgery 8 weeks (average time: 61 days) after radiotherapy. Downstaging of T occurred in 64% and down-staging of N in 50%. The median overall survival (OS) of SCRT alone was 19.5 months. The 1-year, 2-year, 3-year and 5-year OS was 48%, 22%, 14% and 0% respectively. In the surgical group, the median disease-free survival (DFS) and median OS were, respectively, 67 months (95% CI 49.8-83.1 months) and 72.1 months (95% CI 57.5-86.7 months). The 1, 2, 3, 5-year OS was 88%, 75%, 51%, 46%, respectively. Post-operative morbidity was 22%, mortality was 3.4%. Frail patients with advanced rectal cancer are often "unfit" for long-term neoadjuvant chemoradiation. A SCRT may be considered a valid option for this group of patients. Once radiotherapy is completed, patients can be re-evaluated for surgery. If feasible, SCRT and delayed surgery is the best option for frail patients.
Identifiants
pubmed: 33757649
pii: S0748-7983(21)00371-1
doi: 10.1016/j.ejso.2021.03.230
pii:
doi:
Types de publication
Journal Article
Langues
eng
Sous-ensembles de citation
IM
Pagination
2046-2052Informations de copyright
Copyright © 2021 Elsevier Ltd, BASO ~ The Association for Cancer Surgery, and the European Society of Surgical Oncology. All rights reserved.
Déclaration de conflit d'intérêts
Declaration of competing interest The authors do not have any conflicts of interest, or financial ties to disclose.