• Nabila Ansari, Michael J Solomon, Richard J Fisher, John Mackay, Bryan Burmeister, Stephen Ackland, Alexander Heriot, David Joseph, Sue-Anne McLachlan, Bev McClure, and Samuel Y Ngan.
• *Surgical Outcome Research Centre (SOuRCe, The Institute of Academic Surgery at Royal Prince Alfred Hospital, University of Sydney, Sydney, New South Wales, Australia †Peter MacCallum Cancer Centre, Centre for Biostatistics and Clinical Trials, Melbourne, Victoria, Australia ‡Department of Surgical Oncology, Peter MacCallum Cancer Centre, Melbourne, Victoria, Australia §Princess Alexandra Hospital, The University of Queensland, Woolloongabba, Queensland, Australia ¶Department of Oncology, Calvary Mater Hospital, Newcastle, New South Wales, Australia ||Department of Radiation Oncology, Sir Charles Gairdner Hospital, Nedlands, Western Australia, Australia **Department of Oncology, St. Vincent's Hospital, Melbourne, Victoria, Australia ††Department of Medicine, University of Melbourne, Melbourne, Victoria, Australia ‡‡Department of Radiation Oncology, Peter MacCallum Cancer Centre, Melbourne, Victoria, Australia.
• Ann. Surg. 2017 May 1; 265 (5): 882-888.

ObjectiveTo compare acute adverse events (AE) and postoperative complication rates in a randomized trial of short-course (SC) versus long-course (LC) preoperative radiotherapy.BackgroundEvidence demonstrates that adding neoadjuvant radiotherapy to surgery offers better local control in the management of rectal cancer. With both SC and LC therapy there is a potential for acute treatment-related toxicity and increased patient morbidity.MethodsEligible patients had clinical-stage T3 rectal adenocarcinoma within 12 cm of the anal verge with no evidence of metastasis. SC consisted of pelvic radiotherapy 5 × 5 Gy in 1 week, early surgery and 6 courses of adjuvant chemotherapy. LC was 50.4 Gy administered in 28 fractions during 5.5 weeks, with infusion 5-fluorouracil, surgery in 4 to 6 weeks, and 4 courses of chemotherapy.ResultsAll SC patients and 93% of LC patients received preoperative planned radiotherapy. There was no 30-day operative mortality. A statistically significant higher percentage of at least 1 AE occurred in the LC group (SC, 72.3%; LC, 99.4%; P < 0.001). There were significant differences in favor of SC for grade 3 AE: radiation dermatitis (0% vs 5.6%, P = 0.003), proctitis (0% vs 3.7% P = 0.016), nausea (0% vs 3.1%, P = 0.029), fatigue (0% vs 3.7%, P = 0.016) and grade 3/4 diarrhea rates (1.3% vs 14.2% P < 0.001). No statistically significant differences in surgical complication rates were seen (SC 53.2 vs 50.4% LC, p = 0.68), although permanent stoma (38.0% vs 29.8%, P = 0.13) and anastomotic breakdown (7.1% vs 3.5%, P = 0.26) rates favored LC with perineal wound complications (38.3% vs 50.0%, P = 0.26) in favor of SC.ConclusionsLC had significantly higher AEs compared with SC with no statistically significant differences in postoperative complications. There were clinical trends in permanent stoma rates and anastomotic leaks in favor of LC but with an increased perineal wound breakdown rate.

78 keywords...

hide…