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BACKGROUND The standard treatment for locally advanced rectal tumours (LARC)-cT3 lesions with threatened margins, cT4 lesions and node positive lesions is concurrent chemoradiation followed by surgery or short course radiation followed by immediate or delayed surgery. Surgery is total mesorectal excision with either low anterior resection or abdominoperineal resection depending on the location of the tumour. Radiation reduces local recurrence and improves the overall survival. Chemotherapy is given to increase tumour regression and decrease perioperative metastases. Short fractionation schedule of 5 Gy per fraction for 5 days permits sparing of radiotherapy resources, and saves patients of the morbidity of a protracted course of radiation of 28 days, with similar oncologic outcome. Further, the waiting period for surgery improves tumour down staging and pathological complete response rate. METHODS Patients with cT3 or cT4, fixed, node positive LARC received pelvic radiation 5 × 5 Gy and preoperative chemotherapy with FOLFOX regime followed by surgery. RESULTS Of the enrolled 27 patients, the median age of the patient was 57 years (range 40 - 80 years). Acute haematological toxicity was 22 % and G.I. toxicity was 11 %. Primary endpoint namely pathological complete response (ypCR) was noticed in 22 %. R0 resection rates (secondary end point) was 63 %, down staging rate was 66.7 % and sphincter preservation rate was 37.1 %. Surgery was not done in 25.9 %, of whom two were not willing for surgery, one patient became metastatic and rest five were deemed inoperable. Acute wound infection was recorded in two patients (10.2 %) and delayed wound healing (5.2 %) was seen in one patient. CONCLUSIONS Short-course radiotherapy (RT) induces tumour down staging and sphincter preservation with acceptable toxicities, when surgery is performed after chemotherapy at an interval of 6 – 8 weeks for cT3 lesions with threatened margins, cT4 rectal cancer and N0-2 tumours. |
