Surgical and local control outcomes after sequential short-course radiation therapy and chemotherapy for rectal cancer

I-Chia Liu; Susan Gearhart; Suqi Ke; Chen Hu; Haniee Chung; Jonathan Efron; Alodia Gabre-Kidan; Peter Najjar; Chady Atallah; Bashar Safar; Eric S Christenson; Nilofer S Azad; Valerie Lee; Atif Zaheer; Jacqueline E Birkness-Gartman; Abhinav V Reddy; Amol K Narang; Jeffrey Meyer

doi:10.1016/j.sopen.2024.01.015

Surgical and local control outcomes after sequential short-course radiation therapy and chemotherapy for rectal cancer

Surg Open Sci. 2024 Jan 23:18:42-49. doi: 10.1016/j.sopen.2024.01.015. eCollection 2024 Mar.

Authors

I-Chia Liu¹, Susan Gearhart², Suqi Ke³, Chen Hu³, Haniee Chung², Jonathan Efron², Alodia Gabre-Kidan², Peter Najjar², Chady Atallah⁴, Bashar Safar⁴, Eric S Christenson⁵, Nilofer S Azad⁵, Valerie Lee⁵, Atif Zaheer⁶, Jacqueline E Birkness-Gartman⁷, Abhinav V Reddy¹, Amol K Narang¹, Jeffrey Meyer¹

Affiliations

¹ Department of Radiation Oncology & Molecular Radiation Sciences, Johns Hopkins University School of Medicine, Baltimore, MD, USA.
² Department of Surgery, Colorectal Research Unit, Ravitch Division of Colorectal Surgery, Johns Hopkins University School of Medicine, Baltimore, MD, USA.
³ Division of Biostatistics and Bioinformatics, Sidney Kimmel Comprehensive Cancer Center, Johns Hopkins University School of Medicine, Baltimore, MD, USA.
⁴ Department of Surgery, Division of Colon and Rectal Surgery, NYU Langone Health, New York, NY, USA.
⁵ Department of Oncology, Sidney Kimmel Comprehensive Cancer Center at Johns Hopkins, Baltimore, MD, USA.
⁶ Department of Radiology and Radiological Science, Johns Hopkins University School of Medicine, Baltimore, MD, USA.
⁷ Department of Pathology, Johns Hopkins University School of Medicine, Baltimore, MD, USA.

Abstract

Background: Total neoadjuvant therapy (TNT) is an accepted approach for the management of locally advanced rectal cancer (LARC) and is associated with a decreased risk of development of metastatic disease compared to standard neoadjuvant therapy. However, questions remain regarding surgical outcomes and local control in patients who proceed to surgery, particularly when radiation is given first in the neoadjuvant sequence. We report on our institution's experience with patients who underwent short-course radiation therapy, consolidation chemotherapy, and surgery.

Methods: We retrospectively reviewed surgical specimen outcomes, postoperative complications, and local/pelvic control in a large cohort of patients with LARC who underwent neoadjuvant therapy incorporating upfront short-course radiation therapy followed by consolidation chemotherapy.

Results: In our cohort of 83 patients who proceeded to surgery, a complete/near-complete mesorectal specimen was achieved in 90 % of patients. This outcome was not associated with the time interval from completion of radiation to surgery. Postoperative complications were acceptably low. Local control at two years was 93.4 % for all patients- 97.6 % for those with low-risk disease and 90.4 % for high-risk disease.

Conclusion: Upfront short-course radiation therapy and consolidation chemotherapy is an effective treatment course. Extended interval from completion of short-course radiation therapy did not impact surgical specimen quality.

Keywords: Proctectomy; Radiation therapy; Rectal cancer.