Short-course radiation with consolidation chemotherapy does not increase operative morbidity compared to long-course chemoradiation: A retrospective study of the US rectal cancer consortium

Philip S. Bauer, Adriana C. Gamboa, Ebunoluwa E. Otegbeye, William C. Chapman, Samantha Rivard, Scott Regenbogen, Maryam Mohammed, Jennifer Holder-Murray, Jason T. Wiseman, Aslam Ejaz, Kamren Edwards-Hollingsworth, Alexander T. Hawkins, Steven R. Hunt, Glen Balch, Matthew L. Silviera

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1 Scopus citations

Abstract

Background and Objectives: Neoadjuvant short-course radiation and consolidation chemotherapy (SC TNT) remains less widely used for rectal cancer in the United States than long-course chemoradiation (LCRT). SC TNT may improve compliance and downstaging; however, a longer radiation-to-surgery interval may worsen pelvic fibrosis and morbidity with total mesorectal excision (TME). A single, US-center retrospective analysis has shown comparable risk of morbidity after neoadjuvant short-course radiation with consolidation chemotherapy (SC TNT) and long-course chemoradiation (LCRT). Validation by a multi-institutional study is needed. Methods: The US Rectal Cancer Consortium database (2010–2018) was retrospectively reviewed for patients with nonmetastatic, rectal adenocarcinoma treated with neoadjuvant LCRT or SC TNT before TME. The primary endpoint was severe postoperative morbidity. Cohorts were compared by univariate analysis. Multivariable logistic regression modeled the odds of severe complication. Results: Of 788 included patients, 151 (19%) received SC TNT and 637 (81%) LCRT. The SC TNT group had fewer distal tumors (33.8% vs. 50.2%, p < 0.0001) and more clinical node-positive disease (74.2% vs. 47.6%, p < 0.0001). The intraoperative complication rate was similar (SC TNT 5.3% vs. 4.4%, p = 0.65). There was no difference in overall postoperative morbidity (38.4% vs. 46.3%, p = 0.08). Severe morbidity was similar with low anterior resection (9.1% vs. 15.3%, p = 0.10) and abdominoperineal resection (24.4% vs. 29.7%, p = 0.49). SC TNT did not increase the odds of severe morbidity relative to LCRT on multivariable analysis (OR 0.64, 95% CI 0.37–1.10). Conclusions: SC TNT does not increase morbidity after TME for rectal cancer relative to LCRT. Concern for surgical complications should not discourage the use of SC TNT when aiming to increase the likelihood of complete clinical response.

Original languageEnglish
Pages (from-to)254-263
Number of pages10
JournalJournal of surgical oncology
Volume129
Issue number2
DOIs
StatePublished - Feb 2024

Keywords

  • morbidity
  • rectal cancer
  • short-course radiation
  • total neoadjuvant therapy

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