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Waiting four to eight weeks after a short course of radiotherapy is as safe as operating immediately, and it gives time for the tumour to shrink.
Stockholm III randomised 840 patients from eighteen Swedish hospitals between short-course radiotherapy with immediate surgery, short-course radiotherapy with surgery delayed four to eight weeks, and long-course radiotherapy with delayed surgery. Local recurrence occurred in eight of 357, ten of 355 and seven of 128 patients respectively; both delayed arms were non-inferior (hazard ratio for short-course with delay 1.44, 95% CI 0.41 to 5.11; for long-course with delay 2.24, 0.71 to 7.10; p=0.48). Postoperative complications were fewer with delay. The trial made the delayed short course a legitimate option, which is what RAPIDO and STELLAR then built their total neoadjuvant schedules on and what allows organ preservation after a one-week course.
Numbers are from the trial as recorded here; see the source links in the table below. This is orientation, not medical advice: ask your team how closely the trial population matches you.
Shares CAO/ARO/AIO-94 (German Rectal Cancer Study), STELLAR (rectal cancer), IMRT / IGRT (modern external beam), Rectal cancer.
Shares RAPIDO, Rectal cancer.
Shares RAPIDO, IMRT / IGRT (modern external beam), Rectal cancer, Colorectal cancer.
Shares Dutch TME trial, IMRT / IGRT (modern external beam), Rectal cancer, Colorectal cancer.
Shares CAO/ARO/AIO-94 (German Rectal Cancer Study), IMRT / IGRT (modern external beam), Rectal cancer, Colorectal cancer.
Shares Karolinska University Hospital, IMRT / IGRT (modern external beam), Rectal cancer, Colorectal cancer.
Shares CAO/ARO/AIO-94 (German Rectal Cancer Study), Rectal cancer, Colorectal cancer.
Shares RAPIDO, IMRT / IGRT (modern external beam), Rectal cancer, Colorectal cancer.