Palliative Radiation Therapy in the Management of Colon Cancer Patients Unable to Undergo Surgical Resection

Purpose: Patients with localized colon cancer who are not candidates for standard surgical resection present a challenging clinical scenario. The purpose of our study is to report the potential effects of radiotherapy (RT) on palliation of cancer symptoms in patients who are unable to tolerate surgical resection.

Methodology: We retrospectively analyzed patients who were diagnosed with medically inoperable colon adenocarcinoma from 2019-2022 and underwent palliative RT at our institution. Symptoms at diagnosis, during RT, and post-RT were obtained from medical record. We utilized the ECOG performance status scale and CTCAE v5.0 to grade treatment toxicities. Radiological response when available were assessed and overall survival from diagnosis and RT was calculated using the Kaplan-Meier method.

Results: Six patients who underwent palliative RT for colon cancer were identified. Three patients were male, three were female and the average age at diagnosis was 82 years. Two patients had ECOG 2 and four had ECOG 3 performance status. The most common and pertinent symptoms at diagnosis were abdominal pain or discomfort, GI bleeding and fatigue. Most patients received a total radiation dosage of 30 Gy in a 10-fraction course. Many patients had mild acute toxicities of RT and were able to complete their treatment course. After RT, five of six patients reported relief from pain. Two patients who had rectal bleeding at the time of diagnosis reported a reduction of bleeding and five of six patients had improved hematocrit levels after RT. Five of six patients also reported some level of improvement with constitutional symptoms and their energy levels. All five patients who had radiological assessment after RT demonstrated some degree of response to RT with decreased tumor size or thickening. Three patients developed serious adverse events within three months of RT including bacteremia, COPD exacerbation, and a hospitalization due to a fall and failure to thrive after an episode of alcohol intoxication. The median overall survival was 19.2 months from the time of diagnosis and 12.7 months from end of RT.

Conclusions: This retrospective analysis demonstrates that RT is an effective form of palliative treatment for patients with medically inoperable colon cancer. Most patients reported a significant improvement in multiple presenting symptoms of their colon cancer after RT. Overall, the palliative RT treatment was well tolerated without significant acute side effects during radiation. Several patients did develop serious adverse events following RT. However, these likely reflect the severity of their underlying co-morbid conditions rather than RT toxicity alone.

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