Long-Course Chemoradiotherapy (LCRT) Shows Better Outcomes than Short-Course Chemoradiotherapy (SCRT) in Locally Advanced Rectal Cancer (LARC): Insights from Real World Data from A LMIC

Neoadjuvant treatment options like long course RT (LCRT)/Short course RT (SCRT)/ total neoadjuvant treatment (TNT) are the standard of care for locally advanced rectal cancer (LARC).We reviewed the departmental data of LARC for gaining an insight on treatment outcomes with LCRT and SCRT.We analysed data of database of LACR (2014-2020) and compared outcomes of LACR treated with SCRT or LCRT or no treatment.Out of 345 patients registered, complete information regarding treatment was available for 164 patients only.Two third of patients had lower one third tumor, the median tumor length was 6 cm, mesorectal fascia was involved in 42%, node positive were 83%.After LCRT (n=87)/SCRT(n=51), only 43% underwent surgery [low anterior resection:19%/ ultra-low anterior resection:1.5%,abdominoperinealresection:19.6%,and palliative surgery: 3%].The median overall survival and disease-free survival in LCRT was 22 and 21 months and SCRT was 15 and 10 months (P <0.0001) respectively.On univariate analysis factors affecting OS and DFS were length of tumor, MRF involvement, pathological T status, pathological N status , and LCRT versus SCRT.On cox regression ypN positive (HR 2.9, p= 0.006) and type of RT (HR 273, p= 0.001) were retained as significant factors for OS and ypN positive (HR 2.9, p=0.01), and type of RT (HR 29, p=0.001were retained as significant factors affecting DFS.On Propensity score matching median OS and DFS with SCRT and LCRT was 20 months versus 40 months and 10 months versus 52 months respectively (p=0.01 and 0.002).Our data shows that the practice of LCRT results in better outcomes as compared to SCRT.