Neoadjuvant Radiochemotherapy for Locally Advanced Rectal Cancer: A Single-institutional Real-world Study.

Area of Science:

• Oncology
• Gastroenterology
• Surgical Oncology

Background:

• Locally advanced rectal cancer (LARC) requires effective neoadjuvant treatment strategies.
• Neoadjuvant radiochemotherapy (N-RCT) followed by surgery is a standard approach for LARC.
• Real-world data on N-RCT outcomes in LARC are crucial for clinical practice.

Purpose of the Study:

• To evaluate the oncological outcomes and toxicity of neoadjuvant radiochemotherapy (N-RCT) in a real-world cohort of patients with locally advanced rectal cancer (LARC).
• To assess the rates of local recurrence, distant metastasis, and survival after N-RCT and surgery.
• To determine the pathological response, including downstaging and pathological complete response (pCR), following N-RCT.

Main Methods:

• A cohort of 54 patients with middle and lower third LARC received N-RCT (50.4 Gy radiotherapy with capecitabine chemotherapy).
• Volumetric intensity modulated arc therapy (VMAT) was used for radiotherapy delivery.
• Total mesorectal excision (TME) was performed 6-8 weeks post-N-RCT, followed by adjuvant chemotherapy in select cases.

Main Results:

• The 3-year overall survival and disease-free survival rates were 91% and 76%, respectively.
• Pathological downstaging (ypT < cT) was observed in 52% of patients, and ypN ≤ cN in 65%.
• Local recurrence occurred in 7% of patients, distant metastasis in 20%, and a pathological complete response (pCR) in 13% with no grade 3/4 radiogenic side effects.

Conclusions:

• Neoadjuvant radiochemotherapy (N-RCT) followed by total mesorectal excision (TME) demonstrates favorable oncological outcomes and manageable toxicity for LARC.
• The study findings align with existing literature, supporting N-RCT as an effective treatment modality.
• Further research is needed to optimize patient selection and evaluate long-term benefits of novel neoadjuvant strategies.