Case Control Study
Copyright ©The Author(s) 2021. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Clin Cases. Mar 6, 2021; 9(7): 1524-1531
Published online Mar 6, 2021. doi: 10.12998/wjcc.v9.i7.1524
Efficacy and safety of short duration radiotherapy combined with chemotherapy for advanced rectal cancer
Shu-Quan Gao, Ying-Chun Zhang, Chao Zhang, Sheng-Jie Wang, Wei Ren, Na Yuan, Jun-Ye Wen
Shu-Quan Gao, Ying-Chun Zhang, Sheng-Jie Wang, Department of Hepatobiliary Surgery, The First Affiliated Hospital of Hebei North University, Zhangjiakou 075061, Hebei Province, China
Chao Zhang, Department of Interventional Medicine, The First Affiliated Hospital of Hebei North University, Zhangjiakou 075061, Hebei Province, China
Wei Ren, Operating Room, The First Affiliated Hospital of Hebei North University, Zhangjiakou 075061, Hebei Province, China
Na Yuan, Department of Radiotherapy, The First Affiliated Hospital of Hebei North University, Zhangjiakou 075061, Hebei Province, China
Jun-Ye Wen, Department of General Surgery, Hebei Provincial People’s Hospital, Shijiazhuang 050003, Hebei Province, China
Author contributions: Gao SQ and Zhang YC designed the study; Gao SQ, Zhang YC, Zhang C, Wang SJ, Ren W, Yuan N and Wen JY collected the data and materials as well as analyzed the data; all authors wrote the manuscript; Gao SQ and Zhang YC reviewed the manuscript; All authors approved the final version of the manuscript.
Supported by The Key Science and Technology Program of Zhangjiakou, No. 1921132H.
Institutional review board statement: The study was reviewed and approved by the Institutional Review Board of the First Affiliated Hospital of Hebei North University.
Informed consent statement: All study participants, or their legal guardian, provided informed written consent prior to study enrollment.
Conflict-of-interest statement: No conflict of interest for all authors.
Data sharing statement: No additional to be shared.
STROBE statement: The authors have read the STROBE Statement checklist of items, and the manuscript was revised according to the STROBE Statement-checklist of items.
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: Ying-Chun Zhang, MSc, Associate Chief Physician, Associate Professor, Department of Hepatobiliary Surgery, The First Affiliated Hospital of Hebei North University, No. 12 Changqing Road, Qiaoxi District, Zhangjiakou 075061, Hebei Province, China. zhyingchun@sina.cn
Received: December 3, 2020
Peer-review started: December 3, 2020
First decision: December 13, 2020
Revised: December 28, 2020
Accepted: January 15, 2021
Article in press: January 15, 2021
Published online: March 6, 2021
Abstract
BACKGROUND

Radiotherapy or chemoradiotherapy is widely used for the treatment of rectal cancer preoperatively. Although the combination of radiotherapy and chemotherapy as an established preoperative neoadjuvant therapy shows high efficacy in the treatment of rectal cancer, some patients experience a response of poor tolerance and outcomes due to the long duration radiotherapy. The study compared short duration radiotherapy plus chemotherapy vs long duration radiotherapy plus chemotherapy for rectal cancer to determine whether short duration radiation treatment should be considered to diminish complications, reduce risk of recurrence and improve survival in patients with rectal cancer.

AIM

To evaluate the efficacy and safety of short duration radiotherapy combined with chemotherapy for the treatment of advanced rectal cancer.

METHODS

One hundred patients with stage IIIB or higher severe rectal cancer were selected as the study subjects at The First Affiliated Hospital of Hebei North University between December 2018 and December 2019. The patients were assigned to different groups based on the treatment regimens. Fifty patients who received preoperative short durations of radiotherapy plus chemotherapy were enrolled in an observation group and fifty patients who received conventional radiotherapy and chemotherapy were enrolled in a control group. Colonoscopic biopsy was performed for all patients with pathological diagnosis of rectal cancer. The expression of tumor-related factors such as RUNX3 and Ki-67 was quantitatively analyzed using immunohistochemistry in the tissues of the patients before and after treatment. Moreover, the duration of procedure, the amount of bleeding during the operation, the anus-conserving rate, the incidence of postoperative complications (wound infection, anastomotic leakage, postoperative intestinal obstruction, etc.) and postoperative pathology were compared between the two groups. The overall survival rate, recurrence rate and distant metastasis rate were also compared through postoperative reexamination and regular follow-up.

RESULTS

There was no significant difference in the positive expression rate of RUNX3 and Ki-67 between the two groups before the treatment (P > 0.05). Compared with the pretreatment value, the positive rate of RUNX3 was increased and the positive rate of Ki-67 was decreased in both groups after the treatment (all P < 0.05). The incidence of leukopenia, thrombocytopenia, neutropenia and diarrhea were higher in the observation group than in the control group (all P < 0.05). There was no significant difference in the incidence of anemia, fatigue, neurotoxicity and nausea and vomiting between the two groups (all P > 0.05). No significant difference was observed in the duration of procedure, intraoperative bleeding, the anus-conserving rate and the incidence of postoperative complications between the two groups (P > 0.05). After 1 year of follow-up, the 1-yr survival rate was 80.0% in the observation group and 68.0% in the control group, the recurrence rate was 8.0% in the observation group and 10.0% in the control group, the distant metastasis rate was 6.0% in the observation group and 8.0% in the control group difference (all P < 0.05).

CONCLUSION

Short duration radiotherapy combined with chemotherapy can improve the cure rate, prolong the survival time and reduce the incidence of complications in patients with advanced rectal cancer.

Keywords: Short course radiotherapy, Chemotherapy, Advanced rectal cancer, Runx3, Ki-67

Core Tip: Short duration radiotherapy was compared to conventional fractionated radiation treatment plus chemotherapy in 100 patients with stage IIIB or more severe rectal cancer to verify whether short duration preoperative radiotherapy had an advantage in diminishing complications, reducing risk of recurrence and improving survival. The findings revealed that there was no significant difference in the incidence of complications between short and long duration radiotherapy plus chemotherapy. However, short duration radiotherapy improved the 1-yr survival rate and reduced the recurrence rate and distant metastasis rate in comparison with conventional preoperative radiotherapy.