12-72 hours after the last radiotherapy session. Depending on the location of the tumor.

Dear Dr Nagi

the best interval between neoadjuvant radiotherapy and surgery is 6 to 8 weeks

Dear Dr Nagi

I recommend to read this paper:

Send to

Chirurg. 2015 Sep;86(9):874-80. doi: 10.1007/s00104-014-2916-6.

[Timing of esophagectomy in multimodal therapy of esophageal cancer: Impact of time interval between neoadjuvant therapy and surgery on outcome and response].

[Article in German]

Müller AK1, Lenschow C, Palmes D, Senninger N, Hummel R, Lindner K.

Author information

Abstract

BACKGROUND:

Neoadjuvant radiochemotherapy [n(R)CT] has become the standard of care in the multimodal therapy concept for patients with locally advanced esophageal cancer; however, optimal timing of surgery is not clearly defined.

OBJECTIVES:

The study analyzed whether the length of the interval between completion of n(R)CT and surgery can affect the postoperative outcome, tumor response and long-term survival.

MATERIAL AND METHODS:

A total of 106 patients with adenocarcinoma and squamous cell carcinoma of the esophagus, treated between 2006 and 2013, were included in this study. On the basis of the median time interval to surgery, patients were divided into two groups [group A ≤ 40 days (n = 54) and group B > 40 days (n = 52)] and compared concerning demographic data, preoperative risk scores, morbidity, outcome, tumor response and long-term survival.

RESULTS:

The groups were comparable in terms of demographics, preoperative condition of the patients, complications and outcome; however, group A showed a trend towards a higher mortality risk as preoperatively assessed by the physiological and operative severity score for the enumeration of mortality and morbidity in esophagogastric surgery patients (O-POSSUM) (p = 0.064) and group B showed a trend towards a higher rate of complete responders (p = 0.097).

CONCLUSION:

Concerning perioperative morbidity and mortality, delayed surgery after n(R)CT showed no benefit for the patient's outcome; however, the rate of complete tumor response was higher in patients with a time interval of more than 40 days, although this did not influence long-term survival or recurrence rates.

PMID: 25662991 DOI: 10.1007/s00104-014-2916-6

[PubMed - indexed for MEDLINE]

best wishes

My sincere thanks for your answers to my query, does the site of tumor influence the time interval between last session and resection?

If possible radical removal of the tumor, then surgery is performed 12-72 hours after neo-adjuvant radiotherapy on the electron accelerator (large fraction). If the radicalism of the operation is doubtful, or when the planned reconstruction stage in the operation area, or when the histology of the tumor does not provide its reduction by 10% (ex. dense Sa), or... then the neo-adjuvant radiotherapy done with medium or small factions with the operation after 4-6 weeks after its completion. If the hospital has no an electron accelerator, but only cobalt or X-ray therapy, the first version of neo-adjuvant therapy is not possible. 

But it is possible to apply the coarse fractions (cobalt) with the operation after 24-72 hours in order to save time. But it must be remembered that radiotherapy is carried out a lower-dose course. And it would have to be extended to a full dose to the "tumor bed" 2-3 weeks after surgery.

surgery should be contemplated after 4-6 weeks of radiation if significant down staging is expected.

The STOCKHOLM III trial is comparing the same concept for rectal cancer.

If surgery is done too early this down staging will not happen which can increase R1 resection rate.

Depending on the location of the cancer and duration of the radiotherapy time.  Usually it could be minimum 4-6 week or last.

Well sir, depending on the site and the treatment intended, the duration can be 1-8 weeks.

To explain this further, Say in ca rectum SCC RT is followed by surgery in 7 days. And if full dose Neo-adjuvant CTRT is given then 4 weeks is the ideal time for surgery.

But this is very specific to carcinoma rectum.

Otherwise, post radiation 4-6  weeks is generally considered to be the best time.