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Previous trials suggest that short-course radiotherapy with a prolonged interval to surgery (SCRT-delay) could serve as an adequate neoadjuvant treatment for intermediate to high risk rectal cancer, with decreased postoperative complications compared to SCRT and immediate surgery. Furthermore, introduction of an interval after neoadjuvant radiotherapy gives the opportunity for organ-sparing treatment strategies if a clinical complete response is achieved. However, an interval to surgery also introduces radiotherapy-induced toxicity in the interval period. Structured patient reported data on the toxicity during this interval is still lacking. Therefore, in this study we assess the physician and patient reported short-course radiotherapy-induced acute toxicity in the waiting period before surgery for rectal cancer.

All rectal cancer patients referred to the Radiotherapy Department of UMC Utrecht for neoadjuvant SCRT-delay (5 times 5 Gy without immediate surgery) were asked to score low anterior resection syndrome (LARS) symptoms before, during and weekly after radiotherapy. Every week, participating patients were contacted by telephone by the physician or researcher to assess toxicity (dermatitis, diarrhea, fatigue, cystitis and urine incontinence according to CTCAE 4.0). Only descriptive statistics were applied.

20 patients (9 female, 11 male) were included. Median age was 61.5 years (IQR 53.0-69.7). 13 patients received SCRT-delay for intermediate risk rectal cancer, one patient for locally advanced rectal cancer unable to undergo neoadjuvant chemoradiation and 6 patients for oligometastatic disease (M1-scheme). Median interval to surgery was 8 weeks. The majority of patients did not experience dermatitis, fatigue, cystitis or urine incontinence during or after radiotherapy. A transient increase in CTCAE grade 2 or 3 diarrhea was seen 2-3 weeks after SCRT. LARS scores of 16 patients were available for analysis.  88% of patients experienced major LARS within 2 weeks following radiotherapy. Most reported complaints were frequency, urgency and re-evacuation within 1 hour. The majority of patients was free of complaints before they proceeded to surgery. No hospital admissions were recorded during the study period.

Diarrhea and LARS symptoms are most reported within 2-3 weeks following short course radiotherapy for rectal cancer, but these complaints recover before surgery. No grade >3 toxicity was seen in this limited patient group. These results indicate that the SCRT-delay strategy is safe and well tolerated by patients.