Neoadjuvant radiotherapy (5 × 5 Gy): immediate versus delayed surgery

Area of Science:

• Oncology
• Radiation Oncology
• Surgical Oncology

Background:

• The optimal timing of surgery following short-course radiotherapy (SCRT) remains a subject of investigation.
• Understanding the impact of the interval between SCRT and surgery is crucial for treatment optimization.

Purpose of the Study:

• To systematically review and evaluate the role of the interval length between 5 × 5 Gy radiotherapy and surgical intervention.
• To assess the influence of delayed surgery on treatment outcomes, toxicity, and oncological results.

Main Methods:

• A systematic review was conducted using PubMed to identify relevant studies.
• Included studies analyzed outcomes for patients undergoing surgery after 5 × 5 Gy radiotherapy, comparing immediate versus delayed surgical approaches.

Main Results:

• Delayed surgery after 5 × 5 Gy radiotherapy was associated with a higher pathological complete response (pCR) rate (approximately 10% higher).
• Immediate surgery showed a lower rate of severe acute post-radiation toxicity but a higher incidence of minor postoperative complications.
• Short-course radiotherapy with delayed surgery demonstrated favorable outcomes in elderly patients unfit for chemotherapy and in cases of unresectable or early-stage cancers.

Conclusions:

• Delayed surgery following 5 × 5 Gy radiotherapy is a viable strategy for elderly patients unfit for chemotherapy with unresectable or early-stage cancers.
• Short-course radiotherapy combined with consolidation chemotherapy presents a promising treatment option for potentially resectable stage IV disease, achieving higher pCR rates.