The Value of using Short course radiotherapy (SCRT) versus Short course radiotherapy followed by delayed surgery (SCRT-DS) for management of patients with locally advanced rectal cancer (LARC); a comparative study

Document Type : Original Article

Authors

1 General Surgery, Faculty of Medicine, Benha University

2 General surgery department, faculty of medicine, Zagazig university, Zagazig, Egypt

3 Lecturer of Anesthesia and Intensive care, Faculty of Medicine, Zagazig University

4 Medical Oncology, Faculty of Medicine, Zagazig University

5 Clinical Oncology and nuclear medicine, Faculty of Medicine, Zagazig University

6 Pathology Department, Faculty of Medicine, Zagazig University

7 Internal Medicine, Faculty of Medicine, Zagazig University

8 General surgery, Faculty of Medicine, Zagazig University

Abstract

Aim of the present report was to assess the feasibility, toxicity, short and long term outcome in addition to assessing the ability to produce pathological complete response to therapy of using a SCRT and SCRT followed by delayed surgical resection, in patients with a middle and/or low LARC.
Patients and methods:we prospectively assessed 60 patients who were diagnosed with middle and/or low LACR we divided them into; 35 patients underwent SCRT only and 25 patients underwent SCRT followed by delayed surgical resection (SCRT-DS group). We compare between both included groups regarding; short term, long term, surgical and survival outcomes.
Results:All included patients showed disappearance of cancer-related hemorrhage. Cancer-related pelvic pain disappearance happened in80%of patients.
In patients who underwent SCRT alone; complete pathologic response was reported in15%of patients, partial response was reported in 15% of patients and no response was reported in70%of patients. In patients who underwent SCRT-DS complete pathologic response was reported in30%of patients, partial response was reported in 40% of patients and no response was reported in 30% of patients. All the patients have R0 resection margin.
In all included patients down-staging of cancer occurred78.9%of patients without statistically significant differences between both included groups of patients.
Median OS rate and DFS rate were better in the SCRT-DS group than in SCRT group (p =0.049and0.036respectively).
Conclusions:we demonstrated that using SCRT followed by a delayed surgery in patients with a low/middle LARC which were considered “unfit” for LCRT is a feasible and safe management strategy regarding both surgical and oncologic outcomes

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Zagazig University Medical Journal
Volume 29, Issue 4
July and August 2023
Pages 1193-1200

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