Locally advanced rectal adenocarcinoma: Are preoperative short and long course radiotherapy truly equivalent?

Margalit,Ofer; Mamtani,Ronac; Lawrence,Yaacov R.; Yang,Yu‑Xiao; Baruch,Erez N.; Reiss,Kim A.; Golan,Talia; Halpern,Naama; Aderka,Dan; Giantonio,Bruce; Shacham‑Shmueli,Einat; Boursi,Ben

doi:10.3892/mco.2019.1825

May-2019 Volume 10 Issue 5

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May-2019 Volume 10 Issue 5

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Article

Locally advanced rectal adenocarcinoma: Are preoperative short and long course radiotherapy truly equivalent?

Authors:
- Ofer Margalit
- Ronac Mamtani
- Yaacov R. Lawrence
- Yu‑Xiao Yang
- Erez N. Baruch
- Kim A. Reiss
- Talia Golan
- Naama Halpern
- Dan Aderka
- Bruce Giantonio
- Einat Shacham‑Shmueli
- Ben Boursi
View Affiliations / Copyright

Affiliations: Department of Oncology, Sheba Medical Center, Tel‑Hashomer 52621, Israel, Abramson Cancer Center, University of Pennsylvania, Philadelphia, PA 19104, USA, Center for Clinical Epidemiology and Biostatistics, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA 19104, USA, Division of Hematology and Oncology, Department of Medicine, Massachusetts General Hospital, Harvard Medical School, Boston, MA 02114, USA
Pages: 555-559
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Published online on: March 14, 2019

https://doi.org/10.3892/mco.2019.1825
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Abstract

In the neoadjuvant treatment of locally advanced rectal adenocarcinoma, long‑ and short‑course radiotherapy are considered to be of equivalent efficacy based upon several randomized trials. The present study assessed the effect of radiotherapy dose on overall survival. Using the National Cancer Database (2006‑2013) 458 individuals with clinical stage II/III rectal adenocarcinoma treated were identified, with either short‑ (25 Gy) or long‑ (45 or 50.4 Gy) course neoadjuvant radiotherapy followed by surgery, without neoadjuvant or adjuvant chemotherapy. Multivariate COX regression was employed to evaluate differences in overall survival according to radiotherapy regimen. An association with improved overall survival in individuals treated with long‑ compared with short‑course radiotherapy was demonstrated (HR=0.50, 0.34‑0.73). The 30‑ and 90‑day post‑surgery mortality rates were higher in the short‑course group when compared with the long‑course group (12.2 vs. 2.4%; and 18.5 vs. 5.4%, respectively). Following the exclusion of patients that succumbed within 90‑days post‑surgery, overall survival advantage in the long‑course group compared with the short‑course group was maintained [hazard ratio (HR)=0.62, 0.39‑0.99], with a median overall survival of 25.3 months (IQR 16.9‑41.6) for the short‑course group compared with 43.5 months (IQR 25.6‑67.9) for the long‑course group. To the best of our knowledge, the present results suggest for the first time that long‑course radiotherapy is associated with an improved overall survival compared with short‑course radiotherapy in locally advanced rectal adenocarcinoma in the absence of chemotherapy usage. This possible advantage is clinically relevant mainly in patients who cannot tolerate systemic chemotherapy.

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Journals

International Journal of Molecular Medicine

International Journal of Oncology

Molecular Medicine Reports

Oncology Reports

Experimental and Therapeutic Medicine

Oncology Letters

Biomedical Reports

Molecular and Clinical Oncology

World Academy of Sciences Journal

International Journal of Functional Nutrition

International Journal of Epigenetics

Medicine International

Locally advanced rectal adenocarcinoma: Are preoperative short and long course radiotherapy truly equivalent?

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