KEY POINTS
- This multicenter retrospective study included 63 patients treated with hypofractionated palliative radiotherapy for symptomatic locally advanced or metastatic rectal adenocarcinoma across 5 AP-HP radiation oncology departments between 2010 and 2020.
- The cohort was frail and high-risk: median age was 80 years, 86% had T3–T4 disease, 54% had metastatic disease, 49% had ECOG performance status >2, and 68% had a G8 score <14.
- The most common schedules were 25 Gy in 5 fractions in 62% and 30 Gy in 10 fractions in 24%; all patients were treated with 3-dimensional conformal radiotherapy.
- Six-month local control was 46% and 1-year local control was 22.2%; local control was numerically higher with BED >37.5 Gy than BED <37.5 Gy (66.7% vs 33.3%, p = 0.2047), but not statistically significant.
- Overall symptom improvement occurred in 75%; symptomatic control was higher with BED >37.5 Gy (93.3% vs 55.6% for BED <37.5 Gy, p = 0.0027) and with 30 Gy in 10 fractions (92.3%, p = 0.048). Acute grade 3 gastrointestinal toxicity occurred in 6%, and no grade 3 or higher late toxicity was reported.
CLINICAL TAKEAWAY
Higher-BED palliative radiotherapy, particularly schedules such as 30 Gy in 10 fractions, may provide better symptom relief than the commonly used 25 Gy in 5 fractions schedule in frail, elderly, or metastatic rectal cancer patients. The signal is clinically relevant because symptom relief is the main goal in this setting, but the study is retrospective, small, clinician-selected, and lacks standardized patient-reported outcomes. This is useful palliative evidence worth attention, not a definitive dose-fractionation standard.