Phase 1 Study of Neoadjuvant Short-Course Radiation Therapy Concurrent With Infusional 5-Fluorouracil for the Treatment of Locally Advanced Rectal Cancer

CT-Based Adaptive Short Course Radiotherapy for Rectal Cancer: A Case Report

Rectal cancer is a highly prevalent malignancy with an increasing number of treatment strategies and sequencing. Short-course radiotherapy (SCRT) combined with chemotherapy has shown to be a feasible treatment option for non-metastatic disease within the total neoadjuvant therapy paradigm. In contrast to conventionally fractionated chemoradiation, SCRT carries less logistical burden and reduces time off systemic therapy, which is particularly beneficial for patients with metastatic disease. We present a case of a 42-year-old male with metastatic rectal cancer who received SCRT using CT-based adaptive radiation, delivering 25 Gy to the pelvis with a simultaneous integrated boost of 30 Gy to the rectal tumor over five treatments. CT-based adaptive radiation was effective and well-tolerated and offers a pathway towards isotoxic radiotherapy dose escalation for patients considered to be inoperable. This case demonstrates the integration of adaptive SCRT as a promising strategy for rectal cancer.

Patient-reported Bowel Function and Bowel-related Quality of Life After Pelvic Radiation for Rectal Adenocarcinoma: The Impact of Radiation Fractionation and Surgical Resection

INTRODUCTION

Multimodality treatment for locally advanced rectal cancer (LARC) can include long-course radiotherapy (LCRT) or short course radiotherapy (SCRT). Nonoperative management is increasingly pursued for those achieving a complete clinical response. Data regarding long-term function and quality-of-life (QOL) are limited.

METHODS

Patients with LARC treated with radiotherapy from 2016 to 2020 completed the Functional Assessment of Cancer Therapy- General (FACT-G7), the Low Anterior Resection Syndrome Score (LARS) and the Fecal Incontinence QOL Scale (FIQOL). Univariate and multivariable linear regression analyses identified associations between clinical variables including radiation fractionation and the use of surgery versus non-operative management.

RESULTS

Of 204 patients surveyed, 124 (60.8%) responded. Median (interquartile range) time from radiation to survey completion was 30.1 (18.3-43) months. Seventy-nine (63.7%) respondents received LCRT, and 45 (36.3%) received SCRT; 101 (81.5%) respondents underwent surgery, and 23 (18.5%) pursued nonoperative management. There were no differences in LARS, FIQoL or FACT-G7 between patients receiving LCRT versus SCRT. On multivariable analysis, only nonoperative management was associated with lower LARS score signifying less bowel dysfunction. Nonoperative management and female sex were associated with a higher FIQoL score signifying less disruption and distress from fecal incontinence issues. Finally, lower BMI at the time of radiation, female sex, and higher FIQoL score were associated with higher FACT-G7 scores signifying better overall QOL.

CONCLUSIONS

These results suggest long-term patient-reported bowel function and QOL may be similar for individuals receiving SCRT and LCRT for the treatment of LARC, but nonoperative management may lead to improved bowel function and QOL.