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Sustained Organ Preservation in Patients With Rectal Cancer After Sequential Short-Course Radiation Therapy and
I-Chia Liu1, Susan Gearhart2, Chen Hu3
1Department of Radiation Oncology & Molecular Radiation Sciences, The Johns Hopkins University School of Medicine, Baltimore, MD, USA.
The American Surgeon
|May 9, 2025
Summary
Short-course radiation therapy followed by chemotherapy can achieve durable complete responses in rectal cancer patients, enabling successful nonoperative management and organ preservation. This approach shows promising results for disease control and salvage surgery outcomes.
Area of Science:
- Oncology
- Radiation Oncology
- Surgical Oncology
Background:
- Nonoperative management (NOM) is gaining interest for rectal cancer patients achieving complete response (CR) after chemoradiotherapy.
- Most data on NOM focus on long-course chemoradiotherapy; the efficacy of short-course radiation therapy (SCRT) for durable CR and organ preservation is less defined.
Purpose of the Study:
- To evaluate the long-term outcomes of nonoperative management following upfront short-course radiation therapy and sequential chemotherapy in rectal cancer patients.
- To assess disease control, local regrowth rates, and salvage surgery results in this cohort.
Main Methods:
- Retrospective review of 52 patients with nonmetastatic rectal cancer treated with SCRT and consolidation chemotherapy.
- Patients achieving CR were managed nonoperatively, with outcomes including local regrowth and salvage surgery analyzed.
- Characteristics associated with local tumor regrowth were investigated.
Main Results:
- The 2-year freedom from local regrowth was 75% for the entire cohort.
- No patient with a sustained clinical CR developed metastatic disease.
- Of 12 patients undergoing salvage surgery for regrowth, 10 had complete/near-complete resection with negative margins.
Conclusions:
- Neoadjuvant therapy incorporating short-course radiation therapy can achieve durable complete responses in rectal cancer.
- Nonoperative management following SCRT and chemotherapy is a viable strategy for organ preservation, with salvage surgery effective for managing regrowth.
