International Journal of Hematology and Oncology 2024, Vol 34, Num 1 Page(s): 178-184
Neoadjuvant Radiotherapy in Rectal Cancer: A Single Center Experience

Pervin HURMUZ1, Burak TILKI1, Mustafa CENGIZ1, Ferah YILDIZ1, Gokhan OZYIGIT1, Timucin EROL3, Ali KONAN3, Faruk ZORLU1, Suayib YALCIN2, Fadil AKYOL1

1Hacettepe University Faculty of Medicine Department of Radiation Oncology, Ankara, TURKEY
2Hacettepe University Faculty of Medicine Department of Medical Oncology, Ankara, TURKEY
3Hacettepe University Faculty of Medicine Department of General Surgery, Ankara, TURKEY

Keywords: Radiotherapy, Rectal cancer, Surgery, Neoadjuvant radiotherapy, Chemotherapy
Neoadjuvant chemoradiotherapy (CRT) followed by surgical resection is the standard treatment for locally advanced rectal adenocarcinoma. In this study we evaluate our treatment results in patients treated with neoadjuvant radiotherapy (RT). Medical records of 144 patients treated between January 2009 and February 2019 were retrospectively evaluated. Most of the patients had (76%) MRI as a part of initial staging. Patients received either short course (25 Gy/5 fractions) (8%) or long course RT (92%) (median 50.4 Gy/28 fractions) ± chemotherapy (ChT). Median age was 56 years (range, 24-90 years) and 131 patients received CRT. Most common concomitant ChT regime was oral capecitabine (48%). 26 patients refused the surgery. For rest of the patients, median time to surgery was 8 weeks. Sphincter was preserved in 19 patients (38%) who underwent surgery for distal tumors. With a median follow-up of 28 months, 19 patients had local recurrence and 30 patients had distant metastases. Two and five year estimated overall survival (OS), locoregional control (LRC) and distant metastases free survival (DMFS) rates were 88-67%, 78-62% and 74-57%, respectively. Presence of surgery significantly affect OS (HR= 0.147, 95% CI: 0.67-0.32, p< 0.001) , LRC (HR= 0.10, 95% CI: 0.05-0.2, p< 0.001) and DMFS (HR= 0.25, 95% CI: 0.13-0.49). Patients tolerated the treatment well with no grade 3 acute or late gastrointestinal and genitourinary system toxicities. Regardless of the schema neoadjuvant RT seems to be an efficient and safe treatment for patients with rectal adenocarcinoma. We found that surgery is the sole prognostic factor for better OS, LC and DMFS.