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Abstract
Introduction. Two primary preoperative radiotherapy regimens are currently utilized for rectal cancer patients: short-course radiotherapy (SCRT) and prolonged-course chemoradiotherapy (CRT). Despite evidence from phase III randomized trials, optimal indications for each regimen remain undefined. This challenge becomes particularly critical during healthcare system strain, such as pandemics.
Aim. To evaluate immediate treatment outcomes between neoadjuvant radiotherapy regimens for non-metastatic rectal cancer during adverse epidemiological conditions..
Materials and Methods. We conducted a multicenter retrospective cohort study including patients aged 18-82 years with verified non-metastatic rectal cancer receiving radiotherapy between 2019-2022. Participants were stratified into SCRT and CRT groups. Propensity score matching was employed for cohort balancing, followed by analysis of immediate treatment outcomes.
Results. Among 302 initially enrolled patients, propensity matching yielded 94 matched pairs from four institutions. Acute toxicity was significantly more frequent in the CRT group (66% vs 18.1%, p<0.001), with grade 3 toxicity observed in 4.3% of CRT patients versus 0% in SCRT patients. Radiotherapy regimen did not affect circumferential resection margin clearance, lymphovascular invasion rates, sphincter preservation frequency, or pathological complete response rates (20.2% CRT vs 24.5% SCRT, p=0.768). However, treatment-interrupting COVID-19 infections differed significantly between regimens (8.5% CRT vs 1.1% SCRT, p=0.017).
Conclusion. Short-course radiotherapy demonstrates superior safety profiles with reduced toxicity and treatment interruptions while maintaining non-inferior oncological outcomes compared to conventional chemoradiotherapy.
References
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