Short-Term Outcomes and Cost-Effectiveness between Long-Course Chemoradiation and Short-Course Radiotherapy for Locally Advanced Rectal Cancer.

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  • Additional Information
    • Source:
      Publisher: Yonsei University Country of Publication: Korea (South) NLM ID: 0414003 Publication Model: Print Cited Medium: Internet ISSN: 1976-2437 (Electronic) Linking ISSN: 05135796 NLM ISO Abbreviation: Yonsei Med J Subsets: MEDLINE
    • Publication Information:
      Original Publication: Seoul : Yonsei University
    • Subject Terms:
      Chemoradiotherapy*/methods ; Rectal Neoplasms*/drug therapy ; Rectal Neoplasms*/pathology ; Rectal Neoplasms*/radiotherapy ; Rectal Neoplasms*/surgery ; Radiotherapy*/methods; Humans ; Asian People ; Capecitabine/therapeutic use ; Cost-Benefit Analysis ; Neoplasms, Second Primary ; Proctectomy/methods
    • Abstract:
      Purpose: 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.
      Materials and Methods: 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.
      Results: 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 two 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: $18787 vs. $22203, p <0.001) and 40% lower for outpatient treatment (SCRT vs. LCRT: $11955 vs. $19641, p <0.001) compared to LCRT. SCRT was 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 in the total cost of care and distinguished cost-effectiveness compared to LCRT.
      Competing Interests: The authors have no potential conflicts of interest to disclose.
      (© Copyright: Yonsei University College of Medicine 2023.)
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    • Grant Information:
      Korea Boryung Co., Ltd.
    • Contributed Indexing:
      Keywords: Rectal cancer; cost effectiveness; long-course chemoradiation; short course radiotherapy
    • Accession Number:
      6804DJ8Z9U (Capecitabine)
    • Publication Date:
      Date Created: 20230525 Date Completed: 20230601 Latest Revision: 20230603
    • Publication Date:
      20231215
    • Accession Number:
      PMC10232996
    • Accession Number:
      10.3349/ymj.2023.0042
    • Accession Number:
      37226566