Sequential treatment with hypofractionated radiotherapy, chemotherapy and deferred surgery in adenocarcinoma of the lower rectum
Abstract
Introduction: Neoadjuvant hypofractionated radiotherapy in adenocarcinoma of the lower rectum was introduced in Cuba in 2010, in collaboration with the International Energy Organization.
Objective: To evaluate the results of sequential treatment with hypofractionated radiotherapy, chemotherapy and delayed surgery in patients with adenocarcinoma of the lower rectum.
Methods: An observational, retrospective and longitudinal study was carried out in 30 patients treated at INOR (2011-2015). The treatment lasted twelve weeks; week 1, hypofractionated radiation therapy; weeks 4 and 8, Mayo chemotherapy; and deferred surgery until week 12. Survival was estimated using the Kaplan-Meier method and Cox regression for independent variables.
Results: Women predominated (70 %), those over 60 years of age (60 %), and white skin (60 %). Most patients presented tumors within 5 cm of the anal border (53.3 %), stage IIIb (46.7 %), histological grade III (43.3 %) without lymphatic or perineural vascular permeation (46.7 %). Abdominoperineal resection was performed (60 %). There was good tolerance to the treatment: absence of acute toxicity (63.3 %) and late toxicity (73.3 %) postoperative complications (80 %). Pathologic response was a significant prognostic factor in overall survival. Patients with poor pathologic response, tumors more than 5 cm away from the anal border, acute toxicity, lymphatic vascular permeation, and relapses had a higher risk of dying
Conclusion: This study is the first national report on hypofractionated radiotherapy in adenocarcinoma of the lower rectum, which has been shown to be safe and with optimal survival.
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