Evaluating short-course radiation therapy followed by chemotherapy for patients with rectal cancer.

This study evaluated short-course radiation therapy (RT) followed by chemotherapy as a non-surgical treatment of patients with rectal cancer (RC). The data showed that treatment with short-course RT and chemotherapy is safe and effective for these patients.

Colorectal cancer (CRC) is one of the most common types of cancer worldwide. One third of CRC cases involve the rectum (rectal cancer; RC; the final part of the large intestine). The first choice for the treatment of RC is usually surgery. In more advanced stages, chemotherapy with radiation is given before surgery (neoadjuvant chemoradiotherapy; nCRT) to shrink the cancer so that it can be completely removed by surgery. Studies have shown that in some patients, nCRT can entirely remove the cancer so surgery may no longer be needed. 

Chemotherapy can be combined with either short– or long-course RT. All studies treating RC with a non-surgical management have used long-course RT. However, studies evaluating short-course RT followed by chemotherapy for patients with RC are still unknown.

This study involved 19 patients with RC. All patients were treated non-surgically with short-course RT and chemotherapy. RT was given in 5 sessions of 25 Gy. Chemotherapy involved either 5 courses of CAPOX (capecitabine and oxaliplatin) or 8 courses of FOLFOX (folinic acid, fluorouracil, and oxaliplatin). The average follow-up time was 27.7 months.

At the first follow-up, 74% of patients had a clinical complete response rate (cCR; no cancer was found at the rectal examination or seen during an endoscopic examination). After 1 year, this rate was maintained by 68%.

After 2-years, 93% of the patients with cCR were alive without cancer worsening compared to 67% of patients without cCR. After 2-years, 100% of the patients with cCR were alive without cancer spreading (metastasis) compared to 67% of patients without cCR.

After 2-years, the overall survival rates were 100% for patients with cCR versus 67% for patients without cCR.

There was no difference in the patient-reported quality of life scores in colorectal function at 1 year compared with baseline. There were no severe late effects and 89% of patients still undergoing non-surgical management returned to baseline bowel function.

This study concluded that treatment with a non-surgical management involving short-course RT and chemotherapy is safe and effective for the treatment of patients with RC.

The sample size was very small. There was no control arm. Larger studies with longer follow-up are necessary to validate the conclusions.