{'fraction_non_alphanumeric': 0.03965863453815261, 'fraction_numerical': 0.018072289156626505, 'mean_word_length': 5.3471337579617835, 'pattern_counts': {'":': 0, '<': 0, '<?xml version=': 0, '>': 1, 'https://': 0, 'lorem ipsum': 0, 'www.': 0, 'xml': 0}, 'pii_count': 0, 'substrings_counts': 0, 'word_list_counts': {'cursed_substrings.json': 0, 'profanity_word_list.json': 0, 'sexual_word_list.json': 0, 'zh_pornsignals.json': 0}}
Patient- and physician-reported radiation-induced toxicity of short course radiotherapy with a prolonged interval to surgery for rectal cancer.

INTRODUCTION
A prolonged interval (> 4 weeks) between short course radiotherapy (25 Gy in 5 fractions, SCRT-delay) and total mesorectal excision (TME) for rectal cancer has been associated with a decreased postoperative complication rate and offers the possibility of organ preservation in case of a complete tumour response. This prospective cohort study systematically evaluated patient-reported bowel dysfunction and physician-reported radiation-induced toxicity for 8 weeks following SCRT-delay.


MATERIALS & METHODS
Patients who were referred for SCRT-delay for intermediate risk, oligometastatic or locally advanced rectal cancer were included. Repeated measurements were done for patient-reported bowel dysfunction (measured by the low anterior resection syndrome (LARS) questionnaire and categorized as no, minor or major LARS) and physician-reported radiation-induced toxicity (according to CTCAE version 4.0) before start of treatment (baseline), at completion of SCRT and 1, 2, 3, 4, 6 and 8 weeks thereafter.


RESULTS
Fifty-one patients were included; 31 (61%) were male and the median age was 67 years (range 44-91). Patient-reported bowel dysfunction and physician-reported radiation-induced toxicity peaked at week 1-2 after completion of SCRT and gradually declined thereafter. Major LARS was reported by 44 patients (92%) at some time during SCRT-delay. Grade 3 radiation-induced toxicity was reported in 17 patients (33%) and concerned predominantly diarrhoea. No grade 4-5 radiation-induced toxicity occurred.


CONCLUSION
During SCRT-delay, almost every patient experiences temporary mild-moderate radiation-induced toxicity and major LARS, but life-threatening toxicity is rare. SCRT-delay is a safe alternative to SCRT-direct surgery that should be proposed when counseling rectal cancer patients on neoadjuvant strategies.