One-Week versus Two-Week Chemoradiotherapy Followed by Curative Surgery in Rectal Cancer: Long-Term Comparative Pooled Analysis of Two Prospective Multicenter Phase II Trials
1Department of Radiation Oncology, Eunpyeong St. Mary’s Hospital, College of Medicine, The Catholic University of Korea, Seoul, Korea 2Center for Colorectal Cancer, Research Institute and Hospital, National Cancer Center, Goyang, Korea 3Department of Radiation Oncology, Seoul St. Mary’s Hospital, College of Medicine, The Catholic University of Korea, Seoul, Korea 4Department of Radiation Oncology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea 5Department of Radiation Oncology, Seoul National University College of Medicine, Seoul, Korea 6Department of Radiation Oncology, Hwasun Chonnam National University Hospital, Hwansu, Korea 7Department of Radiation Oncology, St. Vincent’s Hospital, College of Medicine, The Catholic University of Korea, Suwon, Korea
Correspondence
Jong Hoon Lee ,Tel: 82-31-249-8440, Fax: 82-31-257-3734, Email: koppul@catholic.ac.kr
Received: December 23, 2022; Accepted: February 20, 2023. Published online: February 27, 2023. *Soo-Yoon Sung, Dae Yong Kim and Hong Seok Jang contributed equally to this work.
ABSTRACT
Purpose
The optimal short-course chemotherapeutic regimen for rectal cancer has not been clearly defined until now. KROG 10-01 and KROG 11-02 prospective trials investigated the efficacy and safety of one- and two-week CRT, respectively.
Materials and Methods
Patients eligible for KROG 10-01 and KROG 11-02 involved those with clinical T3-4N0-2M0 rectal cancers. They received preoperative CRT and total mesorectal excision. Patients in KROG 10-01 received radiation of 25 Gy in 5 fractions during one week with 5-fluorouracil/leucovorin. Patients in KROG 11-02 received radiation of 33 Gy in 10 fractions during two weeks with oral capecitabine.
Results
A total of 150 patients consisting of 70 patients from KROG 10-01 and 80 patients from KROG 11-02 were collectively analyzed. With a median follow-up time of 89.2 months, the 5-year overall survival (OS) rate was 86.5% in one-week CRT and 85.3% in two-week CRT (p=0.84). The 5-year recurrence-free survival (RFS) rate was 83.5% in one-week CRT and 77.1% in two-week CRT (p=0.45). One patient (1.4%) in one-week CRT and eleven patients (13.8%) in two-week CRT exhibited pathologic complete regression (ypT0N0M0) after radiotherapy (p=0.01). One-week CRT had significantly higher acute hematologic (12.8% vs. 3.8%, p=0.040) and non-hematologic (38.6% vs. 16.3%, p=0.002) toxicity than two-week CRT.
Conclusion
Both one- and two-week schedules of CRT showed favorable survival outcomes after seven years of follow-up. But, two-week course achieved more increased tumor response and decreased acute toxicity than one-week course.
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