S737
Clinical – Lower GI
ESTRO 2026
Radiotherapy, Maria Sklodowska-Curie National Research Institute of Oncology, Gliwice, Poland
dysfunction or sexual outcomes at 1-year FUP.Older patients ( ≥ 65 years) reported lower physical functioning (p=0.03) and reduced sexual interest (p=0.03), although bowel dysfunction and global QoL were similar across age groups.The FSFI questionnaire was filled out very heterogeneously by 15/19 female patients, this may reflect a psychological impact on female group.IIEF analysis was filled out by 19/21 male patients. Overall, erectile function did not significantly worsen at 1–2 years compared to baseline and radiation boost had no significant impact on sexual function (p=0.63).
Purpose/Objective: Distant metastases have emerged as a primary cause of treatment failure in modern rectal cancer care, creating an urgent need for better risk-stratification tools. The specific objective of this study is to analyze recent evidence suggesting the Neoadjuvant Rectal (NAR) score, a tool already validated as a surrogate endpoint for overall survival, may also serve as a powerful and practical predictor for early dissemination (1). Material/Methods: This single-center retrospective study included 51 (2023–2024) patients with LARC treated with RAPIDO- like scheme hypofractionated radiotherapy (25 Gy/5 fx) followed by FOLFOX 33 (65 %) pts. or OPRA-like scheme radiochemotherapy (50,4-54 Gy/28-30 fx) followed by FOLFOX 18 (35%) pts.(2,3). Clinical and pathological markers were analyzed, including age (median: 60 years, range 35-74), sex (80% male), tumor location (38% -Low, 53%-Medium -10 % High), cTNM stage: T2-4%, T3-53%, T4-43%, N1- 37%, N2-63%. Results: High-risk features included radiological evidence of a threatened or positive circumferential margin (cCRM+) in 71% and the presence of extramural venous invasion (cEMVI+) in 39% of patients. With NAR threshold of 8 low/high risk was found in 39% vs 61% of patients. KRAS, NRAS and BRAF were mutated in 35%, 3.9% and 1.9% of patients, respectively. The ypCR rate was 24%. Fourteen percent of patients experienced rapid dissemination within one year of surgery. The F-Cox test showed statistical significance for development of metastases in NAR ≤ 8 vs NAR > 8 (p=0.04) (Fig.1). No other parameter assessed, including ypCR, showed a similarly high correlation with the risk of early dissemination. This suggests that the composite nature of the NAR score, which captures the interplay between initial tumor burden and treatment response, provides unique prognostic information.
Conclusion: Radiotherapy dose escalation did not worsen bowel function or overall QoL, however RT boost increased the percentage of NOM. NOM patients experience better functional outcomes, suggesting that strategies increasing complete response rates can enhance QoL in LARC management. References: 1. Chiloiro G, Cusumano D, Boldrini L, Romano A, Placidi L, Nardini M, Meldolesi E, Barbaro B, Coco C, Crucitti A, Persiani R, Petruzziello L, Ricci R, Salvatore L, Sofo L, Alfieri S, Manfredi R, Valentini V, Gambacorta MA. THUNDER 2: THeragnostic Utilities for Neoplastic DisEases of the Rectum by MRI guided radiotherapy. BMC Cancer. 2022 Jan 15;22(1):67. doi: 10.1186/s12885-021-09158-9. PMID: 35033008; PMCID: PMC8760695. Keywords: LARC, QoL, boost The Neoadjuvant Rectal (NAR) Score as a Predictor of Early Metastatic Risk in Locally Advanced Rectal Cancer (LARC) patients treated with TNT Iwona D ę bosz-Suwi ń ska 1 , Agnieszka Badora-Rybicka 2 , Marcin Zeman 3 , Agata Roch-Zniszo ł 1 , Agnieszka Namys ł -Kaletka 1 , Jerzy Wydma ń ski 1 , Rafa ł Suwi ń ski 4 1 Radiotherapy Department, Maria Sklodowska-Curie National Research Institute of Oncology, Gliwice, Poland. 2 Department of Chemotherapy, Maria Sklodowska-Curie National Research Institute of Oncology, Gliwice, Poland. 3 Department of Surgery, e of Oncology, Gliwice, Poland. 4 Oncology and Digital Poster Highlight 4294
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