There are shops out there still performing only long-course radiotherapy for rectal cancer. One has to suspect that in talking to patients they are not bringing up the short-course option, or at least not in any way that fairly explains the extensive data supporting its use.
At this stage in the evidence, this is presumably the fault of antiquated rules for compensation to radiation oncology clinics. Payers have had to be reluctantly dragged out of the era of light boxes and grease pencils. IMRT is still a dirty word in Insurance Land. But here they are shooting themselves in the foot by paying us to give longer, more expensive treatment by compensating us less for shorter care.
In case you don't treat GI cancers, the summary of our current understanding is that short-course radiotherapy, delivered over 5 days, results in equal rates of local control with clinically comparable toxicities when compared with the traditional radiotherapy given with sensitizing chemotherapy over 28 fractions.
Short-course RT is substantially less expensive for patients paying out of pocket. It requires far fewer clinic visits, a huge quality-of-life factor in a population of patients that includes many trying to continue working at jobs far from the cancer center.
