SHORT-COURSE RADIOTHERAPY FOR OLDER PATIENTS WITH LOCALLY ADVANCED RECTAL CANCER AND UNFIT FOR CHEMOTHERAPY: THE SOFT...

Area of Science:

• Oncology
• Gastroenterology
• Geriatric Medicine

Background:

• Treatment for locally advanced rectal cancer (LARC) in elderly patients lacks standardized international guidelines.
• Short-course radiotherapy (SCRT) followed by delayed surgery is an emerging option for older LARC patients.
• SCRT offers potential benefits including reduced treatment time, toxicity, and improved convenience.

Purpose of the Study:

• To evaluate the efficacy and safety of SCRT followed by delayed surgery in older patients with LARC.
• To assess down-staging rates, survival outcomes (RFS, OS, CSS), and safety profiles.
• To determine the feasibility of this treatment approach in patients unfit for chemotherapy.

Main Methods:

• A prospective study involving 141 patients aged ≥70 years with LARC (stage II-III) unfit for chemotherapy.
• Patients received SCRT (25 Gy in 5 fractions) followed by delayed surgery (≥6 weeks post-treatment).
• Data collected included down-staging rates, radiological and pathological response, R0 resection, survival outcomes, morbidity, and mortality.

Main Results:

• Down-staging observed in 61.7% of patients; 7.1% achieved complete radiological response.
• R0 resection rate was 93.6%, with 5.7% achieving pathological complete response (pCR).
• Median relapse-free survival (RFS), overall survival (OS), and cancer-specific survival (CSS) were 31.5, 40.5, and 41.5 months, respectively. Post-operative severe morbidity was 23.4%, and mortality was 2.8%.

Conclusions:

• SCRT followed by delayed surgery is a viable and effective treatment for older LARC patients.
• This approach shows favorable efficacy, limited toxicity, and low mortality compared to conventional treatments.
• SCRT represents a promising alternative for elderly patients with LARC, particularly those unfit for chemotherapy.