Upper Rectal Cancer: To Irradiate or Not?

Introduction This study examines the ongoing debate surrounding treatment strategies for upper rectal cancer. While neoadjuvant chemoradiotherapy (NCRT) is well established for mid and low rectal cancers, its efficacy for upper rectal cancers remains contentious. The objective of this study was to evaluate the safety, clinical outcomes, and oncologic results of chemoradiation in upper rectal cancer. Methods A retrospective cohort study was conducted at Rambam Health Care Hospital in Haifa, Israel, involving patients aged 18 and older diagnosed with locally advanced upper rectal cancer, defined as tumors located 11 to 15 cm from the anal verge, between 2013 and 2022. Patients were categorized into two groups: those who received NCRT prior to surgery and those who underwent surgery directly. The primary outcome measured was the incidence of postoperative complications, while secondary outcomes included mortality rates and the occurrence of local or distant recurrence. Results A total of 31 patients were included in the study, with 18 in the NCRT group and 13 in the surgery-first group. The two groups were comparable in terms of demographics and initial staging. The NCRT group exhibited a higher incidence of postoperative complications (66.7% vs. 38.5%), although this difference was not statistically significant. There were no significant differences in mortality rates or local recurrence between the groups. However, the NCRT group had a significantly higher incidence of low anterior resection syndrome (LARS) (27.8% vs. 0%). Discussion The findings suggest that NCRT does not enhance local control in upper rectal cancer compared to surgery alone. The increased incidence of LARS in the NCRT group underscores potential adverse effects associated with this treatment. These results are consistent with other studies that challenge the benefits of NCRT for upper rectal cancers, indicating a need for cautious interpretation and further research through larger, prospective studies. Conclusions NCRT for upper rectal cancer does not significantly improve local control and is associated with higher rates of LARS. Future studies should aim to optimize treatment protocols to balance efficacy and quality of life for patients with upper rectal cancer.