Surgical and local control outcomes after sequential short-course radiation therapy and chemotherapy for rectal cancer

I-Chia Liu, MD; Susan Gearhart, MD MEd; Suqi Ke, MS; Chen Hu, PhD MS; Haniee Chung, MD; Jonathan Efron, MD; Alodia Gabre-Kidan, MD MPH; Peter Najjar, MD MBA; Chady Atallah, MD; Bashar Safar, MD; Eric S. Christenson, MD; Nilofer S. Azad, MD; Valerie Lee, MD; Atif Zaheer, MD; Jacqueline E. Birkness-Gartman, MD; Abhinav V. Reddy, MD; Amol K. Narang, MD; Jeffrey Meyer, MD MS

Surgery Open Science (Mar 2024)

Surgical and local control outcomes after sequential short-course radiation therapy and chemotherapy for rectal cancer

I-Chia Liu, MD,
Susan Gearhart, MD MEd,
Suqi Ke, MS,
Chen Hu, PhD MS,
Haniee Chung, MD,
Jonathan Efron, MD,
Alodia Gabre-Kidan, MD MPH,
Peter Najjar, MD MBA,
Chady Atallah, MD,
Bashar Safar, MD,
Eric S. Christenson, MD,
Nilofer S. Azad, MD,
Valerie Lee, MD,
Atif Zaheer, MD,
Jacqueline E. Birkness-Gartman, MD,
Abhinav V. Reddy, MD,
Amol K. Narang, MD,
Jeffrey Meyer, MD MS

Affiliations

I-Chia Liu, MD: Department of Radiation Oncology & Molecular Radiation Sciences, Johns Hopkins University School of Medicine, Baltimore, MD, USA
Susan Gearhart, MD MEd: Department of Surgery, Colorectal Research Unit, Ravitch Division of Colorectal Surgery, Johns Hopkins University School of Medicine, Baltimore, MD, USA
Suqi Ke, MS: Division of Biostatistics and Bioinformatics, Sidney Kimmel Comprehensive Cancer Center, Johns Hopkins University School of Medicine, Baltimore, MD, USA
Chen Hu, PhD MS: Division of Biostatistics and Bioinformatics, Sidney Kimmel Comprehensive Cancer Center, Johns Hopkins University School of Medicine, Baltimore, MD, USA
Haniee Chung, MD: Department of Surgery, Colorectal Research Unit, Ravitch Division of Colorectal Surgery, Johns Hopkins University School of Medicine, Baltimore, MD, USA
Jonathan Efron, MD: Department of Surgery, Colorectal Research Unit, Ravitch Division of Colorectal Surgery, Johns Hopkins University School of Medicine, Baltimore, MD, USA
Alodia Gabre-Kidan, MD MPH: Department of Surgery, Colorectal Research Unit, Ravitch Division of Colorectal Surgery, Johns Hopkins University School of Medicine, Baltimore, MD, USA
Peter Najjar, MD MBA: Department of Surgery, Colorectal Research Unit, Ravitch Division of Colorectal Surgery, Johns Hopkins University School of Medicine, Baltimore, MD, USA
Chady Atallah, MD: Department of Surgery, Division of Colon and Rectal Surgery, NYU Langone Health, New York, NY, USA
Bashar Safar, MD: Department of Surgery, Division of Colon and Rectal Surgery, NYU Langone Health, New York, NY, USA
Eric S. Christenson, MD: Department of Oncology, Sidney Kimmel Comprehensive Cancer Center at Johns Hopkins, Baltimore, MD, USA
Nilofer S. Azad, MD: Department of Oncology, Sidney Kimmel Comprehensive Cancer Center at Johns Hopkins, Baltimore, MD, USA
Valerie Lee, MD: Department of Oncology, Sidney Kimmel Comprehensive Cancer Center at Johns Hopkins, Baltimore, MD, USA
Atif Zaheer, MD: Department of Radiology and Radiological Science, Johns Hopkins University School of Medicine, Baltimore, MD, USA
Jacqueline E. Birkness-Gartman, MD: Department of Pathology, Johns Hopkins University School of Medicine, Baltimore, MD, USA
Abhinav V. Reddy, MD: Department of Radiation Oncology & Molecular Radiation Sciences, Johns Hopkins University School of Medicine, Baltimore, MD, USA
Amol K. Narang, MD: Department of Radiation Oncology & Molecular Radiation Sciences, Johns Hopkins University School of Medicine, Baltimore, MD, USA
Jeffrey Meyer, MD MS: Department of Radiation Oncology & Molecular Radiation Sciences, Johns Hopkins University School of Medicine, Baltimore, MD, USA; Corresponding author at: Department of Radiation Oncology and Molecular Radiation Sciences, Johns Hopkins University School of Medicine, 401 North Broadway, Suite 1440, Baltimore, MD 21231, USA.

Journal volume & issue: Vol. 18
pp. 42 – 49

Abstract

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Background: Total neoadjuvant therapy (TNT) is an accepted approach for the management of locally advanced rectal cancer (LARC) and is associated with a decreased risk of development of metastatic disease compared to standard neoadjuvant therapy. However, questions remain regarding surgical outcomes and local control in patients who proceed to surgery, particularly when radiation is given first in the neoadjuvant sequence. We report on our institution's experience with patients who underwent short-course radiation therapy, consolidation chemotherapy, and surgery. Methods: We retrospectively reviewed surgical specimen outcomes, postoperative complications, and local/pelvic control in a large cohort of patients with LARC who underwent neoadjuvant therapy incorporating upfront short-course radiation therapy followed by consolidation chemotherapy. Results: In our cohort of 83 patients who proceeded to surgery, a complete/near-complete mesorectal specimen was achieved in 90 % of patients. This outcome was not associated with the time interval from completion of radiation to surgery. Postoperative complications were acceptably low. Local control at two years was 93.4 % for all patients- 97.6 % for those with low-risk disease and 90.4 % for high-risk disease. Conclusion: Upfront short-course radiation therapy and consolidation chemotherapy is an effective treatment course. Extended interval from completion of short-course radiation therapy did not impact surgical specimen quality.

Published in Surgery Open Science

ISSN: 2589-8450 (Online)
Publisher: Elsevier
Country of publisher: United States
LCC subjects: Medicine: Surgery
Website: https://www.journals.elsevier.com/surgery-open-science/

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