Neoadjuvant Chemoradiation Combined with Regional Hyperthermia in Locally Advanced or Recurrent Rectal Cancer

Area of Science:

• Oncology
• Radiation Oncology
• Surgical Oncology

Background:

• Locally advanced and recurrent rectal cancer (LARC/LRRC) pose significant treatment challenges.
• Neoadjuvant chemoradiotherapy is a standard approach, but response rates can be improved.

Purpose of the Study:

• To evaluate the feasibility and pathological complete response (pCR) rates of neoadjuvant chemoradiotherapy combined with regional hyperthermia (RHT).
• To assess treatment toxicity and efficacy in patients with LARC and LRRC.

Main Methods:

• A prospective trial (HyRec-Trial) included 111 patients with UICC stage IIB-IV or locally recurrent rectal cancer.
• Patients received radiotherapy with concurrent 5-Fluorouracil/Capecitabine, Oxaliplatin, and RHT.
• Feasibility and dose-limiting toxicities (DLT) were assessed in two stages; pCR rates were determined by histopathological analysis.

Main Results:

• Feasibility rates were 90% (Stage 1) and 73% (Stage 2).
• The overall pCR rate was 19% (intention-to-treat). Per-protocol analysis showed pCR rates of 28% for LARC and 38% for LRRC.
• Complete resection (R0) rates were high (99% for LARC, 67% for LRRC) in patients who underwent surgery.

Conclusions:

• The intensified neoadjuvant multimodality treatment regimen was feasible.
• Toxicity rates were comparable to standard chemoradiation protocols.
• The treatment demonstrated a high pCR rate, suggesting it is a promising option for LRRC.