Short-term outcome after neoadjuvant high-dose-rate endorectal brachytherapy or short-course external beam radiotherapy in resectable rectal cancer

• AIM:Total mesorectal excision with preoperative radiotherapy reduces local recurrence in rectal cancer, but radiotherapy increases the risk of complications. The study compared the immediate postoperative outcome after external beam radiotherapy with high dose endorectal brachytherapy (HDREBT).METHOD:Patients (n=318) treated with preoperative HDREBT, (26 Gy over 4 days) followed by surgery after 4-8 weeks were matched with 318 patients from the Swedish Rectal Cancer Register treated with 5 Gy daily over 5 days and surgery in the subsequent week (SCRT) and 318 having surgery alone. All 954 patients were followed for 30 days after surgery. Complications were divided into surgical, cardiovascular and infectious.RESULTS:The SCRT group had fewer cardiovascular complications (3.1%) than HDREBT (9.4%, p=0.002) and RT- (7.2%, p=0.03). Perioperative bleeding was less in HDREBT patients (379.3 ml) than SCRT (947.2 ml; p<0.0001) and RT- (918.9 ml), and the re-intervention rate was lower in HDREBT (4.1%) than SCRT patients (14.2%; p=0.005) and RT- (12.3%; p<0.005). The HDREBT group had fewer R2 resections than the SCRT and RT- groups, but a higher proportion of R0-resections than the RT- group (p=0.03).CONCLUSION:No major differences in postoperative complications were found. HDREBT patients had a higher rate of cardiovascular complications but less perioperative bleeding and fewer re-interventions. A longer interval between radiotherapy and surgery may be beneficial for tumour regression and this could be reflected in the number of radical resections.

Ämnesord

MEDICIN OCH HÄLSOVETENSKAP  -- Klinisk medicin -- Kirurgi (hsv//swe)

MEDICAL AND HEALTH SCIENCES  -- Clinical Medicine -- Surgery (hsv//eng)

MEDICIN OCH HÄLSOVETENSKAP  -- Klinisk medicin -- Cancer och onkologi (hsv//swe)

MEDICAL AND HEALTH SCIENCES  -- Clinical Medicine -- Cancer and Oncology (hsv//eng)

Nyckelord

Rectal cancer; radiotherapy; TME-surgery; complications

Publikations- och innehållstyp

ref (ämneskategori)

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