Nonstandard hypofraction radiotherapy in neoadjuvant chemo-radiation therapy of locally advanced rectal cancer

Introduction: Neoadjuvant chemoradiotherapy has become the standard treatment for locally advanced rectal cancer. Neoadjuvant chemoradiotherapy not only can reduce tumor size and recurrence, but also increase the tumor resection rate and anus retention rate with very slight side effect. Comparing with preoperative chemotherapy, preoperative chemoradiotherapy can further reduce the local recurrence rate and downstage. Methods: In our department of Radiation Oncology were retrospectively analyzed 150 patients with locally advanced rectal cancer from 2008 to 2013. Patients were divided into two groups by randomization. Study of the efficacy of the developed neoadjuvant method of treatment of rectal cancer, with the use of remote nonstandard hypofraction radiotherapy 10 х 4 Gy 3 fraction in week to achieve cumulative dose 40 Gy conducted in patients receiving capecitabine at a dose of 1650 mg/m2 during on the days of radiotherapy in 73 patients (Study group), Control group who receive standard neoadjuvant method of treatment prolonged radiotherapy 26 х 2 Gy cumulative dose 56 Gy conducted in patients receiving capecitabine at a dose of 1650 mg/m2 during on the days of radiotherapy in 78 patients with low and middle rectal cancer. Age of patients is from 56 to 74, with IIIB-C stage (T3-4N0-2M0) (CRM+) of rectal cancer. After a neoadjuvant treatment, all patients underwent surgery within 7-8 weeks. Results: The results of our study were as follows: pCR in 16.4%, a partial response in 46.57% patients. Postoperative complications were seen in 6.8% cases in study group, pCR 15.4%, partial response 46.15% and postoperative complications 6.4% in control group. The rate of 5-year OS 75.34% (p > 0.05), 5 year disease-free survival rate 64.38%, in study group, and in the control group, the results were 5-year OS 74,35% and 5 year disease-free survival rate 65.4%. The rate of local control in both group were identical. Conclusion: Method of neoadjuvant treatment (10 x 4 Gy + capecitabine at a dose of 1650 mg/) in combined therapy of rectal cancer in patients does not affect intra-and postoperative complications and slightly increases the frequency of the local control and 5-year OS. In the hypofractive course of radiotherapy, the amount of fractions will be reduced by increasing the single dose, which will shorten the duration of the treatment course. Developing and implementation of the hypofraction method of radiotherapy by reducing the number of radiotherapy sessions will shorten the duration of the course of radiotherapy from 38 to 22 days, which will improve the tolerability of CRT and the quality of life of patients, and will decrease the usage of equipment and save the financial resources introduced to maintain it. Based on the results analysis obtained, the hypofraction method of radiation therapy will be introduced with neoadjuvant chemoradiotherapy in patients with locally advanced rectal cancer in oncological institutions in Uzbekistan and CIS countries.

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