The Covid-19 pandemic, locally advanced rectal cancer and short course radiotherapy: a challenge, a radical approach and its feasibility. Real world evidence of a public hospital cohort

Keywords

rectal cancer - neoadjuvant - watch and wait - RAPIDO - short course radiotherapy

Introduction: Treatment of locally advanced rectal cancer is based on a combination of radiotherapy and chemotherapy, either as adjuvant or neoadjuvant strategies. Short course radiotherapy followed by neoadjuvant chemotherapy, as described by the RAPIDO trial, was chosen by our Oncology, Radiotherapy and Coloproctological tumor board at Hospital de Clínicas de Porto Alegre during the COVID19 pandemic in order to reduce hospital visits and thus the possibility of transmission and infection by the SARS-COV-2 virus.

Methods: We performed an observational analysis, including all patients treated with short course radiotherapy for locally advanced rectal cancer, at the Hospital de Clínicas de Porto Alegre in the period between January 2019 and December 2022. Metastatic patients were included, either treated with curative or palliative intent. Demographic characteristics, clinical staging, timing of chemotherapy, radiotherapy and surgery were analyzed. Clinical response was evaluated through sigmoidoscopy and digital rectal exam, patients with complete clinical response were offered the watch and wait strategy or surgery, after careful discussion of the benefits and risks.

Results: Ninety-six patients were submitted to short course radiotherapy between January 2020 to March 2023. Seven (7) patients were excluded; 89 patients were included in the final analysis. Fifty-five percent were male; mean age was 62 ±12.5 years; 52.8% were ECOG 1 at the diagnosis. Median CEA at diagnosis was 7 ng/mL (CI 95%:4.4 - 9.8). Sixty-four percent were stage III, 31.4% stage IV, 3.3% stage II and 1.1% stage I. Ninety-eight percent completed the programmed radiotherapy protocol. Clinical response data were available in 63 patients: 98,5% of cases achieved disease control, with only 1,5% progressing during treatment (1 patient), and 28,5% achieved complete response and opted into a watch and wait strategy. After a median follow up of two years, 44% of the WW subgroup had recurrent disease, mostly local and resectable.

Conclusions: Adopting the RAPIDO approach had a positive outcome in our advanced rectal cancer patients. Short course radiotherapy followed by chemotherapy achieved excellent rates of disease control. Almost 30% of the non-metastatic patients undergoing RAPIDO treatment achieved complete clinical response opting into a watch and wait program, showing its feasibility and significance in a context of limited economic resources.

Corresponding author: Lucas Fernando Fabra (e-mail: [e-mail]).

 

MissingLinkText

Die Autoren geben an, dass kein Interessenkonflikt besteht.

Publikationsverlauf

Artikel online veröffentlicht:
06. Mai 2025