Changes in Rectal Radiotherapy practice at a London Teaching hospital during the COVID-19 pandemic

ABSTRACT

Introduction: Strategies for radiotherapy in rectal cancer have changed significantly in the past year, with the publication of the RAPIDO trial and the COVID-19 pandemic. As part of our COVID-19 response we audited and compared our radiotherapy treatments during the first COVID-19 peak with the equivalent period in 2019. Methods: All neoadjuvant rectal radiotherapy patients between 01/03/2019-30/ 06/2019 and 01/03/2020-30/ 06/2020 were identified. Patient demographics, tumour characteristics, radiotherapy treatment and outcome data were collected from electronic hospital records and radiotherapy planning software. Results: Eighteen patients underwent neoadjuvant (chemo-) radiotherapy in 2020 compared to 8 during 2019, >100% increase. 'Ugly' disease was present in 83% (15/18) in 2020 and 88% (7/8) in 2019. More patients received short course radiotherapy (SCRT) (56%, 10/18) and total neoadjuvant therapy (TNT) (72%, 13/18) in 2020 compared to 2019, 12% (1/8) and 50% (4/8) respectively. Surgery was performed in 56% (10/18) with 7 complete resections in 2020, 4 patients await exenteration, 3 declined surgery and 1 progressed. Local control rates were 78% (14/18). Whilst in 2019 surgery was performed in 75% (6/8) with 3 complete resections, 1 patient opted for watch and wait and 1 patient progressed. Local control rates were 75% (6/8). Radiological and pathological response will be presented. Conclusion: Radiotherapy practice has changed significantly in the last 12 months with increased volume of patients, more SCRT and more TNT. This pragmatic response to external pressures shows early indicators of equivalent outcomes. Longer follow up is needed to fully assess the benefit of TNT on reducing distant recurrence.