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Background: The current treatment of locally advanced lower and middle rectum’s adenocarcinoma is well codified. It is based on neoadjuvant radiotherapy (NRT) followed by surgical excision. However, two broad radiotherapy approaches are being debated: short course of hypo-fractionated radiation therapy “SRT” (5 GY × 5 days) and long course concomitant radio-chemotherapy “CRT” using higher radiation dose (45-50 GY over 5 weeks) combined with chemotherapy. The first approach allows taking care of about 4 times more patients compared to the second in a same period. SRT was introduced at a large scale at the Pierre ET Marie Curie center (Algiers) in May 2010 by a new multidisciplinary board (Rectum board), aiming to reduce long-lasting schedules. Purpose: The aim of the current study is to evaluate the SCR introduction effect on the access rate to NRT and also to define its impact on treatment efficacy by assessing the primary tumor response (downsizing and downstaging) and the complete resection margin R0 rates. Patients and methods: In this study, the feasibility of short-course radiotherapy was evaluated. A specimen from 297 patients was studied over 10 years. We took May 2010 as a reference point to divide this specimen into two groups, group 1 in care before May 2010 (n=130) and group 2 treated after May 2010 (n=167). Three therapeutics protocols were used: long-course chemoradiation, short-course radiotherapy and long-course radiotherapy. Results: In the group 1, only 33% (43/130) of patients received NRT (SRT=2.5%, CRT=60.5%, LCR=37%). In the second group (after May 2010), 65% (113/167) of patients were able to access an NRT (SRT=73%, CRT=21%, LCR=6%) (p<0.001). Complete response (ypT0N0) was obtained in 13 patients (30%) of Group 1 and 2 patients (2%) of group 2 (p<0.001). Conclusions: The large scaled introduction of short course radiotherapy and the creation of the rectum board have allowed doubling the number of patients which benefited from neoadjuvant radiotherapy. Although, the complete responses rate had significantly dropped.

Benefits of Neoadjuvant Hypofractionated Radiotherapy in the Treatment of Locally Advanced Adenocarcinomas