title: Clinical results and toxicity for short-course preoperative radiotherapy and total mesorectal excision in rectal cancer patients.
abstract: Short-course preoperative radiotherapy (SCPRT) is an alternative method to chemoirradiation for patients with Stage II and III rectal cancer when no downsizing is needed, but there is still widespread reluctance to use this method because of fear of side effects from high-fraction doses. This paper reports on a single institution patient cohort of operated rectal cancer patients after SCPRT, evaluated for chronic adverse effects, local control, progression-free survival and overall survival. Altogether, 257 patients were treated with SCPRT and surgery including total mesorectal excision (92% total mesorectal excision = TME) between 2002 and 2009. Local control and survival were analyzed. Chronic adverse effects for 154 patients without local relapse were evaluated according to the NCI-CTCAE version 4.0 classification, with a median follow-up of 48 months. We found a 5-year disease-free survival (DFS) and overall survival (OS) of 71%. The 5-year estimated local control (LC) rate was 94%. A positive resection margin was found in 4% of the patients and was significantly correlated with decreased DFS, OS and LC. Chronic adverse effects were reported by 58% of the patients, of which 10% were Grade 3 toxicities. The most frequent Grade 2 toxicity was stool incontinence (13%). Sexual dysfunction was found in 36% of the patients (31% Grade 1 or 2, and only 5% Grade 3). SCPRT combined with TME produced excellent LC rates together with a low rate of high-grade chronic adverse effects.
authors.affiliation: Department of Radiation Oncology, University Hospital Heidelberg, INF 400, 69120 Heidelberg, Germany Clinical Cooperation Unit Radiation Oncology, German Cancer Research Center (DKFZ), Heidelberg, Germany florian.sterzing@med.uni-heidelberg.de.
authors.forename: Florian
authors.initials: F
authors.lastname: Sterzing
authors.affiliation: Department of Radiation Oncology, University Hospital Marburg, Germany.
authors.forename: Frieder
authors.initials: F
authors.lastname: Hoehle
authors.affiliation: Department of Surgery, University Hospital Heidelberg, Germany.
authors.forename: Alexis
authors.initials: A
authors.lastname: Ulrich
authors.affiliation: Department of Radiation Oncology, University Hospital Heidelberg, INF 400, 69120 Heidelberg, Germany.
authors.forename: Alexandra
authors.initials: A
authors.lastname: Jensen
authors.affiliation: Department of Radiation Oncology, University Hospital Heidelberg, INF 400, 69120 Heidelberg, Germany Clinical Cooperation Unit Radiation Oncology, German Cancer Research Center (DKFZ), Heidelberg, Germany.
authors.forename: Jürgen
authors.initials: J
authors.lastname: Debus
authors.affiliation: Department of Radiation Oncology, Katharinen Hospital, Stuttgart, Germany.
authors.forename: Marc
authors.initials: M
authors.lastname: Muenter
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D015984:Causality; D003082:Colectomy / Q000401:mortality; D015897:Comorbidity; D018572:Disease-Free Survival; D019583:Dose Fractionation, Radiation; D005260:Female; D005858:Germany / Q000453:epidemiology; D006801:Humans; D008137:Longitudinal Studies; D008297:Male; D008875:Middle Aged; D009364:Neoplasm Recurrence, Local / Q000401:mortality* / Q000517:prevention & control*; D011300:Preoperative Care / Q000379:methods / Q000401:mortality; D011832:Radiation Injuries / Q000401:mortality*; D018714:Radiotherapy, Adjuvant / Q000379:methods / Q000401:mortality; D020266:Radiotherapy, Conformal / Q000401:mortality*; D012004:Rectal Neoplasms / Q000401:mortality* / Q000628:therapy*; D015996:Survival Rate; D016896:Treatment Outcome
keywords: radiation toxicity; local control; sexual dysfunction; rectal cancer; short-course radiotherapy