The efficacy of hypofractionated preoperative chemoradiotherapy in rectal cancer

Purpose To evaluate the efficacy and toxicity of hypofractionated preoperative chemoradiotherapy (HPCRT) combined with oral capecitabine in patients with rectal cancer. Methods HPCRT was delivered by an intensity-modulated radiotherapy of either 33 Gy to the whole pelvis or 35 Gy in 10 fractions to the primary tumor and 33 Gy to the surrounding pelvis. Surgery was performed 4–8 weeks after HPCRT completion. Oral capecitabine was administered concurrently. Tumor response, toxicity, and survival were analyzed. Results Seventy-six patients were eligible for this study. Patients number of clinical stage I, II, III, and IVA were 5, 29, 36, and 6, respectively. Nine patients (11.8%) achieved a pathological complete response. Sphincter preservation was achieved in 23/32 (71.9%) and 44/44 (100%) of patients with a distal extent from anal verge of ≤ 5 cm and > 5 cm, respectively. Twenty-eight patients (36.8%) achieved T-downstaging, and 25 (32.9%) achieved N-downstaging. Five-year disease-free survival (DFS) was 73.6% and overall survival was 90.6%. In the multivariate analysis for DFS, significant prognostic factors were pathologic nodal stage and lymphovascular space invasion. Six patients with stage IVA underwent salvage treatments after HPCRT completion, and all survived to the final follow-up. Three patients experienced grade 3 postoperative complications. No grade 4 toxicities were observed. Conclusion HPCRT of 33 Gy or 35 Gy in 10 fractions showed similar results to those of long-course fractionation. This fractionation scheme could be beneficial for patients with early stage disease, locally advanced rectal cancer, simultaneous distant metastasis requiring early intervention, or for patients who wish to avoid multiple hospital visits.