Short-course radiotherapy with delayed surgery for rectal cancer : a third option
Mené sur 840 patients atteints d'un adénocarcinome du rectum, cet essai multicentrique évalue, du point de vue du délai avant récidive locale et par rapport à une radiothérapie de longue durée suivie d'une résection 4 à 8 semaines plus tard (chirurgie retardée), la non infériorité de deux protocoles de radiothérapie de courte durée en combinaison avec une chirurgie immédiate ou une chirurgie retardée
Rectal cancers can be divided into three groups according to risk of recurrence: early, intermediate, and locally advanced. For intermediate-risk tumours (mostly cT3 without threatened or involved mesorectal fascia) either short-course radiotherapy (5 × 5 Gy) with immediate surgery or chemoradiation (45–50·4 Gy at 1·8–2 Gy per fraction with fluoropyrimidine) with delayed surgery is recommended. Two randomised trials compared these two schedules and showed no difference in postoperative morbidity, oncological outcomes, or late toxicity; a lower frequency of early radiation-induced complications was noted after short-course radiotherapy with immediate surgery compared with chemoradiation.
The Lancet Oncology , commentaire, 2016