Preoperative radiotherapy 5 × 5 Gy and short versus long interval between surgery for resectable rectal cancer: 10-Year follow-up of the randomised controlled trial

• Published in: Radiotherapy and oncology 2021-11, Vol.164, p.268-274
• Main Authors: Pach, Radoslaw, Sierzega, Marek, Szczepanik, Antoni, Popiela, Tadeusz, Richter, Piotr
• Format: Article
• Language: English
• Subjects: Dose Fractionation, Radiation; Follow-Up Studies; Humans; Interval surgery; Neoadjuvant Therapy; Neoplasm Recurrence, Local; Neoplasm Staging; Rectal cancer; Rectal Neoplasms - pathology; Rectal Neoplasms - radiotherapy; Rectal Neoplasms - surgery; Short-course preoperative radiotherapy; Survival Rate
• ISSN: 0167-8140; 1879-0887
• DOI: 10.1016/j.radonc.2021.10.006

•No differences in the overall 10-year survival between immediate and delayed surgery.•Downstaging after radiotherapy associated with significantly better 10-year survival.•Delayed surgery demonstrated an increased risk of local relapse over a 10-year follow-up.•Upstaging and the same stage after 5x5 Gy radiotherapy associated with similar survival. Studies on short-course preoperative radiotherapy in combination with total mesorectal excision for rectal cancer reported improved local control without clear survival benefits. The optimal fractionation and interval between radiotherapy and surgery are still under debate. We, therefore, aimed to report 10-year results of a randomized clinical trial (RCT, NCT01444495) comparing different time intervals between irradiation and surgery for rectal cancer. Data from the RCT conducted at a single academic centre were reviewed based on regular control visits with the median follow-up of 12 years. Patients with rectal cancer were randomly assigned to short-course preoperative radiotherapy (5 × 5 Gy) followed by surgery 7–10 days (short interval) or 4–5 weeks (long interval) after the end of irradiation. The primary endpoint was the local recurrence rate at 5 years. The secondary endpoints included overall survival, disease-free survival, systemic recurrence rate, and downstaging. A total of 154 patients were randomly assigned to short (n = 77) or long interval (n = 77) surgery. The cumulative incidence of local recurrence at 10 years was 1.3% and 11.7% in the short and long-interval groups, respectively (p = 0.031). Accordingly, the incidence of systemic relapse was 14.3% versus 9.1% (p = 0.0319). There were no differences in the overall 10-year survival between patients subject to short and long-interval surgery (58% vs 61%, p = 0.754). However, patients with downstaging after radiotherapy had significantly better 10-year survival rates than non-responders. Short-course preoperative radiotherapy with delayed surgery demonstrated an increased risk of local relapse over a 10-year follow-up.