PREOPERATIVE RADIOTHERAPY VERSUS POSTOPERATIVE RADIOTHERAPY IN RECTAL CANCER: REAL-WORLD OUTCOMES FROM A TERTIARY CANCER CENTRE
Main Article Content
Keywords
Carcinoma rectum, radiotherapy, upper rectum.
Abstract
Background:
Rectal adenocarcinoma presents unique treatment related challenges because of its anatomical location and higher chances of local recurrences. Preoperative chemoradiation is standard for mid and lower rectal diseases whereas it is not equally established in upper rectal cancers. This study aims to evaluate the 3-year overall survival and disease-free survival in curatively treated rectal cancer patients, focusing on tumour location and use of preoperative radiotherapy for upper rectal cancers.
Methods:
Total 123 patients who underwent curative treatment for rectal cancer between January 2019 and December 2021 were included in this study. Tumour location was classified based on distance from anal verge into upper (10-15 cm), mid (5-10 cm) and lower (up to 5 cm). Data were collected retrospectively from case sheets and electronic medical records, analysed using SPSS version 29.
Results:
Majority had stage II-III disease. 91% were non metastatic on presentation. Preoperative radiation was given to 95.9%, (61% SCRT NACT and 39% long course chemoradiation). 3-year overall survival was 75.6% with median not reached, and disease-free survival was 74.6% with median of 67 months. No statistically significant difference in survival was observed based on tumour location, although mid rectal tumours had a lower 3-year OS compared to upper and low rectal group. Preoperative radiotherapy was not associated with significant change in OS or DFS compared with postoperative radiotherapy. Post operative morbidity was comparable between preoperative and post operative radiation groups.
Conclusion:
Tumour location and radiation timing did not impact the survival significantly in this retrospective study. Preoperative radiotherapy achieved excellent local control without any significant increase in morbidity. Certain low risk upper rectal cancers may be omitted preoperative radiation without compromising on the 3-year survival outcomes. Prospective studies are required for validation.
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Dr. Bonny A Joseph
Department of Surgical Oncology, Malabar Cancer Centre, Thalassery, Kerala, India.
Dr. Nizamudheen M Pareekutty
Department of Surgical Oncology, Malabar Cancer Centre, Thalassery, Kerala, India.
Dr Akhil P Suresh
Department of Radiation Oncology, Malabar Cancer Centre, Thalassery, Kerala, India.
Dr. Prasanth Poolakkil
Department of Surgical Oncology, Malabar Cancer Centre, Thalassery, Kerala, India.
Dr. Satheesan Balasubramanian
Department of Surgical Oncology, Malabar Cancer Centre, Thalassery, Kerala, India.
Dr Geetha Muttath
Department of Radiation Oncology, Malabar Cancer Centre, Thalassery, Kerala, India.
Aparna S Nair
Department of Medical Radiology Technology, Malabar Cancer Centre, Thalassery, Kerala, India.
Dr Ratheesan K
Department of Cancer Registry & Epidemiology, Malabar Cancer Centre, Thalassery, Kerala, India.