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Initial results of a randomized controlled trial comparing clinical and pathological downstaging of rectal cancer after preoperative short‐course radiotherapy or long‐term chemoradiotherapy, both with delayed surgery
Author(s) -
Latkauskas T.,
Pauzas H.,
Gineikiene I.,
Janciauskiene R.,
Juozaityte E.,
Saladzinskas Z.,
Tamelis A.,
Pavalkis D.
Publication year - 2012
Publication title -
colorectal disease
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.029
H-Index - 89
eISSN - 1463-1318
pISSN - 1462-8910
DOI - 10.1111/j.1463-1318.2011.02815.x
Subject(s) - medicine , colorectal cancer , chemoradiotherapy , randomized controlled trial , pathological , radiation therapy , surgery , radiology , cancer
Aim The aim of this study was to compare the downstaging achieved after long‐course chemoradiotherapy (chRT) and short‐term radiotherapy (sRT) followed by delayed surgery. Method A randomized controlled trial was carried out. Eighty‐three patients with resectable stage II and III rectal adenocarcinoma were randomized to receive long‐course chemoradiotherapy (46) and short‐term radiotherapy (5 × 5Gy) (37). Surgery was performed 6 weeks after preoperative treatment in both groups. Results The R0 resection rate was 91.3% in the chRT and 86.5% in the sRT group ( P = 0.734). Sphincter preservation rates were 69.6% vs 70.3% ( P = 0.342) and postoperative complication rates were 26.1% vs 40.5% ( P = 0.221). There were more patients with early pT stage [pT0 (complete pathological response) pT1] in the chRT group [21.8% vs 2.7% ( P = 0.03)] and more patients with pT3 disease in the sRT group [75.7% vs 52.2% ( P = 0.036)]. There were no differences in pN stage and lymphatic or vascular invasion in either group. Pathological downstaging (stage 0 and I) was observed in eight (21.6%) patients in the sRT group and in 18 (39.1%) in the chRT group ( P = 0.07). Tumours were smaller after preoperative ChRT (2.5 cm vs 3.3 cm; P = 0.04). Conclusion Long‐course preoperative chemoradiation resulted in greater statistically significant tumour downsizing and downstaging compared with short‐term radiation, but there was no difference in the R0 resection rates. Similar postoperative morbidity was observed in each group.