Dr. Ehab Mahrous Orabi :: Publications:

Background: Management of patients with locally advanced rectal carcinoma (LARC) is different than early-stage rectal carcinoma, as only surgical management of this cancer is related to higher incidence of cancer recurrence, whether distant or local recurrence. Using SCRT in addition to immediate surgery is another valid management option. But there are still some patients too frail for chemo-radiation and promising results were found with the strategy of using radiotherapy followed by delayed surgery performance for a better management of LARC patients. Aim of the present report was to assess the feasibility, toxicity, short- and long-term outcome in addition to assessing the ability to produce pathological complete response to therapy of using a SCRT and SCRT followed by delayed surgical resection, in patients with a middle and/or low LARC. Patients and methods: we prospectively assessed 60 patients who were diagnosed with middle and/or low LACR we divided them into; 35 patients underwent SCRT only and 25 patients underwent SCRT followed by delayed surgical resection (SCRT-DS group). We compare between both included groups regarding, short term, long term, surgical and survival outcomes. Results: All included patients showed disappearance of cancer-related hemorrhage. Cancer-related pelvic pain disappearance happened in 80% of patients. In patients who underwent SCRT alone; complete pathologic response was reported in 15% of patients, partial response was reported in 15% of patients and no response was reported in 70% of patients. In patients who underwent SCRT-DS complete pathologic response was reported in 30% of patients, partial response was reported in 40% of patients and no response was reported in 30% of patients. All the patients have R0 resection margin. In all included patients down-staging of cancer occurred 78.9% of patients without statistically significant differences between both included groups of patients. Median OS rate and DFS rate were better in the SCRT-DS group than in SCRT group (p =0.049 and 0.036 respectively). Conclusions: we demonstrated that using SCRT followed by a delayed surgery in patients with a low/middle LARC which were considered “unfit” for LCRT is a feasible and safe management strategy regarding both surgical and oncologic outcomes.