Short-term outcomes and cost-effectiveness between long-course chemoradiation and short-course radiotherapy followed by consolidation chemotherapy for the treatment of locally advanced rectal cancer

Abstract

Abstract Background: 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 emergedWe aimed to compare these two methods in terms of short-term outcomes and cost analysis under Korean medical insurance system. Materials and methods: 62 patients with high-risk rectal cancer underwent either SCRT or LCRT followed by total mesorectal excision (TME) and classified into two groups. Twenty-seven patients received 5 Gy × 5 with two cycles of XELOX (capecitabine 1,000 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 was assessed between the two groups. Result: Pathological complete response was achieved in 18.5% and 5.7% of patients in the SCRT and LCRT groups, respectively (p = 0.223). The 2-year recurrence-free survival rate did not show significant difference between the groups (SCRT vs. LCRT: 91.9% vs. 76.2%, p = 0.394). The average total cost per patient for SCRT was 18% lower for inpatient treatment (SCRT vs. LCRT: $18,787 vs. $22,203, p < 0.001) and 40% lower for outpatient treatment (SCRT vs. LCRT: $11,955 vs. $19,641, p < 0.001) compared to LCRT. SCRT has been shown to be the dominant treatment option with fewer recurrences and fewer complications at a lower cost. Conclusion: SCRT was well-tolerated and achieved favorable short-term outcomes. In addition, SCRT showed significant reduction of total cost of care and distinguished cost-effectiveness compared to LCRT.