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Korean Journal of Clinical Oncology > Article
ORIGINAL ARTICLE
Korean J Clin Oncol. 2021;17(2): 111-116.         doi: https://doi.org/10.14216/kjco.21017
Short-course radiotherapy and chemotherapy for conversion surgery in patients with unresectable metastatic rectal cancer: a preliminary case series study
Youngbae Jeon1 , Kyoung-Won Han1 , Seok Ho Lee2 , Sun Jin Sym3 , Seung Joon Choi4 , Seung Yeon Ha5 , Jeong-Heum Baek1
1Division of Colon and Rectal Surgery, Department of Surgery, Gil Medical Center, Gachon University College of Medicine, Incheon, Korea
2Department of Radiation Oncology, Gil Medical Center, Gachon University College of Medicine, Incheon, Korea
3Division of Hematology and Oncology, Department of Internal Medicine, Gil Medical Center, Gachon University College of Medicine, Incheon, Korea
4Department of Radiology, Gil Medical Center, Gachon University College of Medicine, Incheon, Korea
5Department of Pathology, Gil Medical Center, Gachon University College of Medicine, Incheon, Korea
Corresponding Author: Jeong-Heum Baek ,Tel: +82-32-460-8428, Fax: +82-32-460-3247, Email: gsbaek@gilhospital.com
Received: June 3, 2021;  Accepted: October 15, 2021.
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ABSTRACT
Purpose: Curative treatment is challenging in patients with locally advanced rectal cancer and unresectable metastases. The aim of this study was to evaluate the clinical outcomes of short-course radiotherapy (RT) followed by systemic chemotherapy for patients with rectal cancer with mesorectal fascia (MRF) involvement and unresectable distant metastases.
Methods: The study included consecutive patients diagnosed as having metastatic mid-to-low rectal cancer treated with short-course RT followed by systemic chemotherapy for conversion radical or palliative surgery between 2014 and 2019 at Gil Medical Center. The patients had primary rectal tumors involving the MRF and unresectable distant metastases. The treatment strategies were determined in a multidisciplinary team discussion.
Results: Seven patients (five men and two women) underwent short-course RT (5 × 5 Gy) and preoperative systemic chemotherapy. The median age was 68 years (range, 46–84 years), and the median distance from the anal verge to the primary tumor was 6.0 cm (range, 2.0–9.0 cm). During the median follow-up period of 29.4 months, three patients underwent conversion radical surgery with R0 resection, two underwent palliative surgery, and two could not undergo surgery. No postoperative major morbidity or mortality occurred. The patients who underwent conversion complete radical surgery showed good long-term survival outcomes, with an overall survival time of 29.4–48.8 months and progression-free survival time of 14.7–41.1 months.
Conclusion: Short-course RT followed by systemic chemotherapy could provide patients with unresectable stage IV rectal cancer a chance to undergo to conversion radical surgery with good long-term survival outcomes.
Keywords: Radiotherapy | Rectal cancer | Metastasis | Surgery
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