Long-term follow-up of Locally Advanced Cancer Rectum Patients who Received Either Neoadjuvant Short Course Radiotherapy or Neoadjuvant Conventional Chemoradiation

Background: Neoadjuvant radiotherapy with or without chemotherapy plays an 
important role in the treatment of LACR as it helps to decrease the size of the 
tumor and achieve sphincter preservation in addition to improving the local 
control. The optimal radiotherapy fractionation to be used is still debatable. Our 
study aimed to compare between preoperative short course RT and long course 
CRT regarding disease response and complications. 
Methods: This retrospective study analyzed the data of all rectal cancer patients 
who received neoadjuvant treatment either short course radio therapy or long 
course chemoradiation during the period from January 2012 to December 2020, 
at radiation oncology department, south Egypt cancer Institute, Assiut 
University. The radiotherapy dose in Group (A) was 2500 cGY /5 fractions 500 
cGY per fraction over 1 week, while in Group (B) was 4500 cGY /25 fractions 
(180 cGY per fraction,5 fractions per week, over 5 weeks) for standard risk PTV 
then 540 cGY /3 fractions boost for high risk PTV to complete 5040 cGY. 
patients in group (A) didn’t received chemotherapy, while patients in group (B) 
received either capecitabine 825 mg/m2
twice daily with radiotherapy or 5-
Flourouracil prescribed at 225 mg/m2 + leucovorin given I.V in the first 3 days 
and last 3 days of the radiotherapy course.
Results: Our study revised records of 66 rectal cancer patients with median 
follow-up period 45 months. Median age was 42 and 45 years for group (A) and 
group (B) respectively. The median overall survival was 45 and 49 months for 
group (A) and (B) respectively. The median disease free survival was 35 and 36 
months for group (A) and (B) respectively. 36 cases (100.0%) in group (B) 
developed early toxicities versus 27 cases (90.0%) in group (A) (P=0.089). 
Diarrhea, mucous discharge, and fecal incontinence were more prevalent among 
patients in group (B) compared to group (A) (P=0.001, 0.001, and 0.017) 
respectively. Grade 3 toxicity was found only in group (B) patients, 3 cases (8.3 
%) developed grade 3 diarrhea and 1 case (2.8%) developed grade 3 mucous 
discharge. three cases in group (A) (10.0%) versus only one case in group (B) 
(2.8%) developed late toxicity. 
Conclusion: Neoadjuvant short course RT is comparable to and long course 
CRT for treatment of LACR.