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Eur J Surg Oncol ; 47(8): 2046-2052, 2021 08.
Artigo em Inglês | MEDLINE | ID: mdl-33757649

RESUMO

OBJECTIVE: The endpoint of the present study was to evaluate the outcomes of short-course radiotherapy (SCRT) and SCRT with delayed surgery (SCRT-DS) on a selected subgroup of frail patients with locally advanced middle/low rectal adenocarcinoma. METHODS: From January 2008 to December 2018, a total of 128 frail patients with locally advanced middle-low rectal adenocarcinoma underwent SCRT and subsequent restaging for eventual delayed surgery. Rates of complete pathological response, down-staging, disease free survival (DFS) and overall survival (OS) were analyzed. RESULTS: 128 patients completed 5 × 5 Gy pelvic radiotherapy. 69 of these were unfit for surgery; 59 underwent surgery 8 weeks (average time: 61 days) after radiotherapy. Downstaging of T occurred in 64% and down-staging of N in 50%. The median overall survival (OS) of SCRT alone was 19.5 months. The 1-year, 2-year, 3-year and 5-year OS was 48%, 22%, 14% and 0% respectively. In the surgical group, the median disease-free survival (DFS) and median OS were, respectively, 67 months (95% CI 49.8-83.1 months) and 72.1 months (95% CI 57.5-86.7 months). The 1, 2, 3, 5-year OS was 88%, 75%, 51%, 46%, respectively. Post-operative morbidity was 22%, mortality was 3.4%. CONCLUSIONS: Frail patients with advanced rectal cancer are often "unfit" for long-term neoadjuvant chemoradiation. A SCRT may be considered a valid option for this group of patients. Once radiotherapy is completed, patients can be re-evaluated for surgery. If feasible, SCRT and delayed surgery is the best option for frail patients.


Assuntos
Adenocarcinoma/terapia , Fragilidade/complicações , Protectomia/métodos , Radioterapia Conformacional/métodos , Neoplasias Retais/terapia , Abscesso/epidemiologia , Adenocarcinoma/complicações , Adenocarcinoma/patologia , Adenocarcinoma/fisiopatologia , Idoso , Idoso de 80 Anos ou mais , Dor do Câncer/etiologia , Dor do Câncer/fisiopatologia , Colectomia , Fístula do Sistema Digestório/epidemiologia , Intervalo Livre de Doença , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Terapia Neoadjuvante/métodos , Estadiamento de Neoplasias , Complicações Pós-Operatórias/epidemiologia , Neoplasias Retais/complicações , Neoplasias Retais/patologia , Neoplasias Retais/fisiopatologia , Estudos Retrospectivos , Infecção da Ferida Cirúrgica/epidemiologia , Taxa de Sobrevida
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