Patient- and physician-reported radiation-induced toxicity of short course radiotherapy with a prolonged interval to surgery for rectal cancer

M E Verweij, S Hoendervangers, C M von Hebel, A Pronk, A H W Schiphorst, E C J Consten, A B Smits, J T Heikens, E G G Verdaasdonk, T Rozema, H M Verkooijen, W M U van Grevenstein, M P W Intven

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Abstract

Aim: A prolonged interval (>4 weeks) between short-course radiotherapy (25 Gy in five fractions) (SCRT-delay) and total mesorectal excision for rectal cancer has been associated with a decreased postoperative complication rate and offers the possibility of organ preservation in the case of a complete tumour response. This prospective cohort study systematically evaluated patient-reported bowel dysfunction and physician-reported radiation-induced toxicity for 8 weeks following SCRT-delay. Method: Patients who were referred for SCRT-delay for intermediate risk, oligometastatic or locally advanced rectal cancer were included. Repeated measurements were done for patient-reported bowel dysfunction (measured by the low anterior resection syndrome [LARS] questionnaire and categorized as no, minor or major LARS) and physician-reported radiation-induced toxicity (according to Common Terminology Criteria for Adverse Events version 4.0) before start of treatment (baseline), at completion of SCRT and 1, 2, 3, 4, 6 and 8 weeks thereafter. Results: Fifty-one patients were included; 31 (61%) were men and the median age was 67 years (range 44–91). Patient-reported bowel dysfunction and physician-reported radiation-induced toxicity peaked at weeks 1–2 after completion of SCRT and gradually declined thereafter. Major LARS was reported by 44 patients (92%) at some time during SCRT-delay. Grade 3 radiation-induced toxicity was reported in 17 patients (33%) and concerned predominantly diarrhoea. No Grade 4–5 radiation-induced toxicity occurred. Conclusion: During SCRT-delay, almost every patient experiences temporary mild–moderate radiation-induced toxicity and major LARS, but life-threatening toxicity is rare. SCRT-delay is a safe alternative to SCRT-direct surgery that should be proposed when counselling rectal cancer patients on neoadjuvant strategies.

Original languageEnglish
Pages (from-to)24-30
Number of pages7
JournalColorectal Disease
Volume25
Issue number1
Early online date29 Aug 2022
DOIs
Publication statusPublished - Jan 2023

Keywords

  • low anterior resection syndrome
  • patient-reported outcomes
  • radiation-induced toxicity
  • rectal cancer
  • short course radiotherapy

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