title: Could preoperative short-course radiotherapy be the treatment of choice for localized advanced rectal carcinoma?
abstract: Short-course preoperative radiotherapy (RT) is widely used in northern Europe for locally advanced resectable rectal cancer, but its role in the era of advanced imaging techniques is uncertain. Here, we reviewed articles and abstracts on SCRT published from 1974 through 2013 with the goal of identifying patients who might be best suited for short-course RT. We included relevant articles comparing surgery with or without preoperative radiation published before and after the advent of total mesorectal excision. We also analyzed two randomized trials directly comparing short-course RT with conventionally fractionated chemoradiation (the Polish Colorectal Study Group and the Trans-Tasman Radiation Oncology Group) that compared short-course RT with conventional chemoradiotherapy. We conclude from our review that short-course RT can be generally applied for operable rectal cancer and produces high rates of pelvic control with acceptable toxicity; it reduces local recurrence rates but does not increase overall survival. SCRT seems to be best used for tumors considered "low risk," i.e., those that are >5 cm from the anal margin, without circumferential margin involvement, and involvement of fewer than 4 lymph nodes. Whether sequential chemotherapy can further improve outcomes remains to be seen, as does the best time for surgery (immediately or 6-8 weeks after RT). We further recommend that selection of patients for short-course RT should be based on findings from magnetic resonance imaging or transrectal ultrasonography.
authors.affiliation: Departments of Radiation Oncology and Radiation Physics, IDOH Instituto de Oncohematología Hospital, Universitario Donostia, Donostia, Basque Country, Spain.
authors.forename: Juan Pablo
authors.initials: JP
authors.lastname: Ciria
authors.affiliation: Departments of Radiation Oncology and Radiation Physics, IDOH Instituto de Oncohematología Hospital, Universitario Donostia, Donostia, Basque Country, Spain.
authors.forename: Mikel
authors.initials: M
authors.lastname: Eguiguren
authors.affiliation: Departments of Radiation Oncology and Radiation Physics, IDOH Instituto de Oncohematología Hospital, Universitario Donostia, Donostia, Basque Country, Spain.
authors.forename: Sergio
authors.initials: S
authors.lastname: Cafiero
authors.affiliation: Departments of Radiation Oncology and Radiation Physics, IDOH Instituto de Oncohematología Hospital, Universitario Donostia, Donostia, Basque Country, Spain.
authors.forename: Intza
authors.initials: I
authors.lastname: Uranga
authors.affiliation: Departments of Radiation Oncology and Radiation Physics, IDOH Instituto de Oncohematología Hospital, Universitario Donostia, Donostia, Basque Country, Spain.
authors.forename: Ivan
authors.initials: I
authors.lastname: Diaz de Cerio
authors.affiliation: Departments of Radiation Oncology and Radiation Physics, IDOH Instituto de Oncohematología Hospital, Universitario Donostia, Donostia, Basque Country, Spain.
authors.forename: Arrate
authors.initials: A
authors.lastname: Querejeta
authors.affiliation: Departments of Radiation Oncology and Radiation Physics, IDOH Instituto de Oncohematología Hospital, Universitario Donostia, Donostia, Basque Country, Spain.
authors.forename: Jose Maria
authors.initials: JM
authors.lastname: Urraca
authors.affiliation: Departments of Radiation Oncology and Radiation Physics, IDOH Instituto de Oncohematología Hospital, Universitario Donostia, Donostia, Basque Country, Spain.
authors.forename: Julian
authors.initials: J
authors.lastname: Minguez
authors.affiliation: Departments of Radiation Oncology and Radiation Physics, IDOH Instituto de Oncohematología Hospital, Universitario Donostia, Donostia, Basque Country, Spain.
authors.forename: Elena
authors.initials: E
authors.lastname: Guimon
authors.affiliation: Departments of Radiation Oncology and Radiation Physics, IDOH Instituto de Oncohematología Hospital, Universitario Donostia, Donostia, Basque Country, Spain.
authors.forename: Jose Ramón
authors.initials: JR
authors.lastname: Puertolas
keywords: Locally advanced rectal cancer; Neoadjuvant radiation therapy; Prognostic factors; Short course preoperative radiotherapy