The effect of neoadjuvant short-course radiotherapy and delayed surgery versus chemoradiation on postoperative outcomes in locally advanced rectal cancer patients – a propensity score matched nationwide audit-based study
Menée aux Pays-Bas à partir de données portant sur 2 926 patients atteints d'un cancer rectal de stade localement avancé, cette étude évalue, du point de vue des complications postopératoires et du taux de réponse complète, l'intérêt d'une radiothérapie néoadjuvante de courte durée en combinaison avec une chirurgie retardée par rapport à une chimioradiothérapie néo-adjuvante en combinaison avec une chirurgie non retardée
Objective : To investigate differences in postoperative outcomes between short-course radiotherapy and delayed surgery (SCRT-delay) and chemoradiation (CRT) in patients with locally advanced rectal cancer (LARC). Background : Previous trials suggest that SCRT-delay could serve as an adequate neoadjuvant treatment for LARC. Therefore, in frail LARC patients SCRT-delay is recommended as an alternative to CRT. However, data on postoperative outcomes after SCRT-delay in comparison to CRT is scarce. Methods : This was an observational study with data from the Dutch ColoRectal Audit (DCRA). LARC patients who underwent surgery (2014-2017) after an interval of ≥6 weeks were included. Missing values were replaced by multiple imputation. Propensity score matching (PSM), using age, Charlson Comorbidity Index, cT-stage and surgical procedure, was applied to create comparable groups. Differences in postoperative outcomes were compared between SCRT-delay and CRT. Results : 2,926 patients were included. In total, 288 patients received SCRT-delay and 2,638 patients underwent CRT. Patients in the SCRT-delay group were older, had more comorbidities. Also, ICU-admissions and permanent colostomies were more common, as well as pulmonic, cardiologic, infectious and neurologic complications. After PSM, both groups comprised 246 patients with equivalent age, comorbidities and tumor stage. There were no differences in postoperative complications. Conclusion : Postoperative complications were not increased in LARC patients undergoing SCRT-delay as neoadjuvant treatment. Regarding treatment-related complications, SCRT-delay is a safe alternative neoadjuvant treatment option for frail LARC patients.