Background

When treating rectal adenocarcinoma, preoperative LCCRT has been shown to reduce local recurrence rates. However adding chemotherapy increases toxicity. We reviewed patients undertaking LCCRT to assess rates of treatment compliance and the influence of specific adverse effects.

Methods

A retrospective assessment of all patients treated with LCCRT using infusional 5-fluorouracil from January 2011 to December 2013 was conducted. Data was extracted for radiation and chemotherapy start and finish dates including treatment delays.

Results

131 patients were identified. 113 were treated with curative intent and 18 palliatively. The median duration of chemotherapy was 5 weeks (5 weeks for curative, 5.5 weeks for palliative). 13 (10%) of patients received ≤3 weeks, 10 (8%) 4 weeks, 45 (34%) 5 weeks, 63 (48%) all 6 weeks. Toxicity was the reason for cessation in all. 120 (92%) completed all fractions of radiation therapy, 8 (6%) 25 fractions and 3 (2%) patients received 20 fractions or less.

Conclusion

LCCRT is associated with well recognised toxicity. Data from our cohort shows that the proportion of patients unable to complete the prescribed 6 weeks of combined modality treatment is not insignificant. This is despite being treated in a unit that treats large numbers of these patients.   As the majority still received 30 fractions of radiation therapy, chemotherapy cessation to avoid worsening toxicity may have limited any compromise to radiation delivery.