Main Session
Sep
27
PQA 01 - Gastrointestinal Cancer and Central Nervous System
Presenter(s)
Rasika Sangle, MD, MBBS - Tata Memorial Hospital, Mumbai, Maharashtr
R. K. Sangle1, R. Engineer1, S. Gudi1, R. Krishnatry1, M. Kazi2, A. Todkar1, A. Ramaswamy3, V. Ostwal3, A. Baheti4, and A. deSouza5; 1Department of Radiation Oncology, Tata Memorial Centre, Homi Bhabha National Institute, Mumbai, India, 2Department of Surgical Oncology, Tata Memorial Centre, Homi Bhabha National Institute, MUMBAI, India, 3Department of Medical Oncology, Tata Memorial Centre, Homi Bhabha National Institute, Mumbai, India, 4Department of Radiodiagnosis, Tata Memorial Centre, Homi Bhabha National Institute, Mumbai, India, 5Department of Surgical Oncology, Tata Memorial Centre, Homi Bhabha National Institute, Mumbai, India
Purpose/Objective(s):
The incidence of rectal cancer in young age is globally rising, however clinical outcomes in very early onset cohort (=30 years age) remain poorly defined particularly in patients treated with radiotherapy. Our study aims to evaluate survival outcomes and failure patterns in such population treated at our center.Materials/Methods:
We retrospectively reviewed institutional database from January 2020 till December 2023. All patients of age = 30 years with locally advanced rectal cancer at diagnosis were selected. A total of 1845 patients were screened. We excluded > 30 years age metastatic or nonmetastatic cohort (n= 1640), very young cohort = 30 years with metastasis at presentation or who progressed before radiation (n=97). Final analysis was done with 108 patients who were treated with radical intent. Baseline demographics including age, stage, EMVI, MRF status, treatment course, and pathological complete response (pCR) were studied. Radiation was given either with short course radiotherapy (25Gy/5fractions) or long course chemoradiation (50Gy/25 fractions) with or without brachytherapy. Survival endpoints included overall survival (OS), disease-free survival (DFS), local control (LC), and distant metastasis-free survival (DMFS), recorded using the Kaplan–Meier method.Results:
In our study, The mean age was 25.3 ± 3.7 years, predominantly male (72.6%). All were locally advanced tumors with majority lower rectum (61.6%). Known high risk features EMVI was seen in 47.2%, MRF involvement in 60.2% poorly differentiated and signet histology accounting for 50% of cohort. Surgery was performed in 75%, 4.6% patients were kept on watch and wait and majority were unwilling for surgery due to personal or social reasons (20.3%). Pathological complete response (pCR) was achieved in 17.6% of patients. At median follow-up of 28 months (range 1-64 months), 2 year and 3 year OS were 90.5% and 88.8% respectively. Corresponding DFS rates were 74% and 64.3%. DMFS at 3 years was 69.4% signifying the predominant mode of failure despite good locoregional control (88.4% at 3 years).Conclusion:
Very early onset rectal cancers (= 30 years) exhibit aggressive disease biology and distal failure being a key therapeutic challenge.Abstract 2200 – Table 1
| Characteristic | Overall (N = 108) |
| Radiation course, n (%) | |
| SCRT | 53 (49.1) |
| LCRT | 55 (50.9) |
| Grade, n (%) | |
| NOS-WD | 13 (12) |
| MD | 40 (38) |
| PD Signet | 26 (24.1) 29 (26.9) |
| Site, n (%) | |
| Upper | 17 (15.7) |
| Middle | 25 (23.1) |
| Lower | 66 (61.1) |
| T stage, n (%) | |
| T2 | 2 (1.9) |
| T3 | 58 (53.7) |
| T4a T4b | 27 (25) 21 (19.4) |
| N stage, n (%) | |
| N0 N1 | 8 (7.4) 42 (38.9) |
| N2 | 58 (53.7) |
| Family history of any malignancy, n (%) | |
| No | 95 (88) |
| Yes | 13 (12) |