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Tumour response and toxicity analysis of preoperative short-course radiation therapy followed by delayed surgery in carcinoma rectum

Vishnu Asokan, Dinesan M, Bindu G, Ajayakumar T.

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Colorectal cancer is the second most common cancer in women and third among men worldwide. The aim of the study is to assess radiological downstaging, pathological response, toxicity following short-course radiation therapy in the neoadjuvant treatment of locally advanced carcinoma rectum.
Materials & methods:
20 Patients with locally advanced carcinoma rectum were studied by a prospective single-group Cohort Study. Target volumes were delineated using RTOG contouring guidelines. Short course radiotherapy with a dose of 25 Gy in 5 fractions, once daily for 5 days delivered using 3D conformal radiotherapy. The toxicity was assessed following radiation and during surgery. After 6 weeks, pelvic MRI did and categorized according to MRI tumour regression grade. Surgery was done at 6-8 weeks. Pathological response assessed using Mandard tumour regression grade.
66.67 % of patients with T3N1 disease and 88.89 patients with T3N2 disease had statistically significant grade 3 tumour regression on MRI. 66.67% of patients with T3N2 disease and 50% with T3N1 disease attained statistically non-significant grade 3 pathological tumour regression. One T3N0 patient attained pathologic complete response. Most of the patients had grade1 or grade 2 toxicity.
Tumour downstaging occurs when surgery is delayed by 6-8 weeks after short-course radiotherapy in T3N0 /N+ locally advanced rectal cancers, with an acceptable toxicity profile

Key words: Chemoradiation, Short course Radiotherapy, Tumour Regression Grade

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