1627P Management of locally advanced rectal cancer during the COVID-19 outbreak: First results of a shift towards short course neoadjuvant radiotherapy

Abstract

Background: Alike other tumor types, it was recommended that the management of locally advanced rectal cancer (LARC) during the COVID outbreak would shift towards hypofractionated RT schemes. Short-course neoadjuvant radiotherapy (SCRT) is comparable to long-course chemoradiation (CRT) in terms of toxicity and survival;nevertheless, CRT is still largely used, especially in advanced tumors. We aim to report the clinical-pathological characteristics and first treatment results of patients treated in a 3-month period during COVID-19 outbreak and to compare them to those treated in the previous year. Methods: We retrospectively reviewed consecutive cases of patients with LARC treated with neoadjuvant RT during Apr-Jun 2020 and Apr-Jun 2019 (control group). Chi square and independent T tests were used for comparison. Results: During Apr-Jun 2020, 35 patients (median age 62 [31-86] years, median Charlson score 4 [2-8]) were treated with neoadjuvant RT. Primary tumor was staged as cT2 (6%), cT3 (57% T3a-b, 17% T3c-d) and cT4 (17% T4a, 3% T4b);83% were cN+;11% patients were M1 at diagnosis and had primary CT. All patients were treated with SCRT (25Gy/5Gyfr);20% patients had perioperative CT and 46% had adjuvant CT. In the control group (n=34), 9 patients had SCRT and 25 had CRT (50.4Gy, 1.8Gyfr, plus capecitabine);6% had primary CT for M1 disease and 6% had perioperative CT. Both groups (2019 vs 2020) were comparable in terms of clinical-pathological variables (age, comorbidities, TNM stage, mesorectal fascia involvement, R0 margin). Pathological complete response (9% vs 11%, p=0.720), modified Ryan tumor regression score ≥2 (74% vs 80%, p=0.456) and rate of postoperative complications ≥III-b (20% vs 9%, p=0.357) also did not differ. Median time from diagnosis to start of RT was 58±43 days vs 61±31 days, p=0.448. Median time to delayed surgery was 66±18 days vs 67±18 days, p=0.948. The start of RT was postponed in 1 patient due to COVID+. Conclusions: Patient characteristics and time to neoadjuvant RT did not appear to differ during COVID-19 outbreak. A shift towards a safer treatment for LARC during this period did not seem to impact pathological response neither postoperative complications. Legal entity responsible for the study: The authors. Funding: Has not received any funding. Disclosure: All authors have declared no conflicts of interest.