The Division of Colon and Rectal Surgery, Department of Surgery, Yonsei University College of Medicine, Seoul, Korea.
Department of Radiation Oncology, Yonsei University College of Medicine, Seoul, Korea.
Yonsei Med J. 2023 Jun;64(6):395-403. doi: 10.3349/ymj.2023.0042.
Long-course chemoradiotherapy (LCRT) has been widely recommended in a majority of rectal cancer patients. Recently, encouraging data on short-course radiotherapy (SCRT) for rectal cancer has emerged. In this study, we aimed to compare these two methods in terms of short-term outcomes and cost analysis under the Korean medical insurance system.
Sixty-two patients with high-risk rectal cancer, who underwent either SCRT or LCRT followed by total mesorectal excision (TME), were classified into two groups. Twenty-seven patients received 5 Gy×5 with two cycles of XELOX (capecitabine 1000 mg/m² and oxaliplatin 130 mg/m² every 3 weeks) followed by TME (SCRT group). Thirty-five patients received capecitabine-based LCRT followed by TME (LCRT group). Short-term outcomes and cost estimation were assessed between the two groups.
Pathological complete response was achieved in 18.5% and 5.7% of patients in the SCRT and LCRT groups, respectively (=0.223). The 2-year recurrence-free survival rate did not show significant difference between the two groups (SCRT vs. LCRT: 91.9% vs. 76.2%, =0.394). The average total cost per patient for SCRT was 18% lower for inpatient treatment (SCRT vs. LCRT: $18787 vs. $22203, <0.001) and 40% lower for outpatient treatment (SCRT vs. LCRT: $11955 vs. $19641, <0.001) compared to LCRT. SCRT was shown to be the dominant treatment option with fewer recurrences and fewer complications at a lower cost.
SCRT was well-tolerated and achieved favorable short-term outcomes. In addition, SCRT showed significant reduction in the total cost of care and distinguished cost-effectiveness compared to LCRT.
长程放化疗（LCRT）已被广泛推荐用于大多数直肠癌患者。最近，直肠癌短程放疗（SCRT）的令人鼓舞的数据已经出现。在这项研究中，我们旨在根据韩国医疗保险系统比较这两种方法在短期结果和成本分析方面的差异。
62 例高危直肠癌患者，行 SCRT 或 LCRT 后行全直肠系膜切除术（TME），分为两组。27 例患者接受 5 Gy×5 与两周期 XELOX（卡培他滨 1000 mg/m²和奥沙利铂 130 mg/m²每 3 周）序贯 TME（SCRT 组）。35 例患者接受卡培他滨为基础的 LCRT 后行 TME（LCRT 组）。评估两组间短期结果和成本估算。
SCRT 和 LCRT 组的病理完全缓解率分别为 18.5%和 5.7%（=0.223）。两组 2 年无复发生存率无显著差异（SCRT 与 LCRT：91.9%与 76.2%，=0.394）。SCRT 组患者的平均总治疗费用，住院治疗费用低 18%（SCRT 与 LCRT：$18787 与 $22203，<0.001），门诊治疗费用低 40%（SCRT 与 LCRT：$11955 与 $19641，<0.001）。SCRT 是一种耐受良好的治疗方法，复发率低，并发症少，成本低。
SCRT 耐受性良好，短期结果良好。此外，与 LCRT 相比，SCRT 显示总治疗费用显著降低，具有成本效益。
