Preoperative Short-Course Radiation Therapy in Rectal Cancer

Purpose: To evaluate the benefits of preoperative short-course radiotherapy in locally advanced rectal cancer.Patients and methods: A prospective study of 30 rectal cancer patients at T3-4M0 stage and ECOG 0-2 performed preoperative short-course radiation therapy at Hue Central Hospital Vietnam between June 2016 and July 2018, using pelvic 3D-Conformal Radiation Therapy with the total radiation dose being 25 Gy in 5 fractions over five days. Results: Mean age 57.1 ± 13.6 with 46.7% of patients in the range of 41-60 year-old. Male/female ratio: 2/1. Tumour stage T3 and T4 was 70% and 30%, respectively; stage III and stage IV was 86.7% and 13.3%, respectively. Positive lymph node rates on endoscopic ultrasound were 85.7% in T3 and 77.8% in T4. Downstaging rate for stage III, T4 and T3 was 65.4%, 65.4% and 4.8%, respectively. For upper third of the rectum: 100% of T3 stage patients got no downstaging. For middle rectum: downstaging rate for stage III, T4 and T3 was 55.6%, 57.1% and 7.1%, respectively. For lower rectum: downstaging rate for stage III, T4 was 50.0% and 100.0%, respectively. No acute toxicity was seen,86.7% of the patients performed laparoscopic sphincter-preserving surgery. Conclusion: For the treatment of locally advanced rectal cancer, neoadjuvant therapy is standard. Preoperative short-course radiation therapy is a reasonable therapeutic option because it demonstrates benefits in tumour downstaging especially for middle and lower rectum.