title: Point: short-course radiation therapy is preferable in the neoadjuvant treatment of rectal cancer.
abstract: There are 2 types of neoadjuvant radiation regimens accepted as standard for resectable rectal cancer: short-course (5 × 5 Gy) radiation therapy alone with immediate surgery and long-course combined chemoradiation therapy with delayed surgery. A Polish randomized study (n = 312) and an Australian randomized study (n = 326) compared these 2 schedules. Both trials showed a lower rate of early adverse effects using a short-course radiation regimen and no differences in long-term oncologic outcomes and late toxicity rates between groups. The small number of fractions makes short-course radiation less expensive and more convenient than chemoradiation therapy. These facts indicate that short-course radiation is preferable to chemoradiation for resectable cancers. Additionally, short-course preoperative radiation with a long interval to surgery is a valuable option for patients unfit for chemotherapy, with unresectable cancer or with a small tumor that is amenable to local excision. Moreover, short-course radiation enables the intensification of both radiotherapy and chemotherapy in patients with metastatic rectal cancer with potentially resectable synchronous metastatic disease.
authors.affiliation: Department of Radiotherapy, Maria Sklodowska-Curie Memorial Cancer Centre, Warsaw, Poland. bujko@coi.waw.pl
authors.forename: Krzysztof
authors.initials: K
authors.lastname: Bujko
authors.forename: Magdalena
authors.initials: M
authors.lastname: Bujko
mesh_terms: D017024:Chemotherapy, Adjuvant; D019583:Dose Fractionation, Radiation; D019317:Evidence-Based Medicine; D006801:Humans; D008207:Lymphatic Metastasis; D020360:Neoadjuvant Therapy / Q000592:standards*; D009367:Neoplasm Staging; D011300:Preoperative Care / Q000592:standards; D011879:Radiotherapy Dosage; D016032:Randomized Controlled Trials as Topic; D012004:Rectal Neoplasms / Q000188:drug therapy / Q000532:radiotherapy* / Q000601:surgery; D015996:Survival Rate; D013997:Time Factors