Abstract

Background: The most frequent cancer in the world is colorectal cancer (CRC). It is the third most typical cancer in men to be diagnosed. Clinical staging is frequently used to determine when to start neoadjuvant chemotherapy and radiation therapy for rectal cancer (NACRT). Therefore, both for care and prognosis, the correctness of that first staging is crucial.
 
Methods: Fifteen rectal cancer patients who receive radical radiation (dose escalation in addition to standard neoadjuvant chemoradiation and undergo surgery). Rectal cancer patients who receive dose escalation in addition to standard neoadjuvant chemoradiation (prescribed whole pelvis radiotherapy dose of 50.4 Gy with additional 9 Gy BOOST to GTV Primary with a margin under standard fraction as 1.8 Gy per fraction for 5 days a week for 7 - 8 weeks with concurrent capecitabine during the days of radiation) will be included in the study. After receiving preop treatment, the clinical and radiological response shall be assessed and planned for surgery as indicated.
 
Results: N=6 patients underwent surgery at 6 weeks after chemoradiotherapy. N=7 patients after 7 weeks and n=2 patients after 8 weeks of chemoradiotherapy. Clinical (POSTNACTRT MRI) down staging of tumor: Stage 2A – 3 pts – all downgraded to stage 1 after NACTRT Stage 3B – 12 pts – 11 patients downgraded to lower stage after NACTRT.  In our study, out of 15 patients, 5 patients (33.33%) had a complete pathological response. Rest 10 patients (66.67%) had an incomplete pathological response.
 
Conclusion: the Neoadjuvant CTRT with dose escalation (Radical RT) in carcinoma rectum patients is Pathological complete response is increased. Downsizing and down staging of tumor clinically (Post NACTRT MRI). Increased sphincter saving surgeries. The toxicity of radiation dose escalation is acceptable and tolerable The latest literature favors towards wait and watch and organ preserving approach after complete clinical response.