According to an article recently published in the New England Journal of Medicine, chemotherapy survival rates are similar among patients with rectal cancer whether chemotherapy is given before or after surgery.

The rectum is the last portion of the large intestine. Standard treatment for rectal cancer often includes the surgical removal of as much of the cancer as possible. Unfortunately, surgery for the removal of rectal cancer may result in loss of sphincter control. In an attempt to combat this, researchers have been evaluating the effects of chemotherapy or radiation therapy prior to surgery, referred to as neoadjuvant therapy.

The concept behind neoadjuvant therapy is to shrink the cancer as much as possible prior to surgery so that the cancer may be completely removed with minimal surgery, thus maintaining sphincter control.

Furthermore, chemotherapy may immediately start killing cancer cells throughout the body, versus postponing chemotherapy until the patient has healed from surgery. Most patients with rectal cancer who are to undergo surgery are treated with radiation therapy prior to surgery.

The impact on long-term survival with the use of neoadjuvant chemotherapy, however, has not been well established.

Researchers affiliated with the European Organization for Research and Treatment of Cancer (EORTC) recently conducted a clinical trial evaluating neoadjuvant chemotherapy for the treatment of rectal cancer. This trial included 1,011 patients with rectal cancer. They were divided into four treatment groups. One group of patients was treated with preoperative radiation only, one group was treated with preoperative chemotherapy only, one group was treated with preoperative radiation and preoperative chemotherapy, and one group was treated with preoperative radiation and chemotherapy followed by postoperative chemotherapy.

  • At five years survival rates did not differ between patients who received preoperative chemotherapy and those who received chemotherapy postoperatively; the survival rate was 65.2% for all four groups.
  • Cancer recurrences at or near the site of origin occurred in approximately 8–9% of patients treated with pre- or postoperative chemotherapy, compared with 17% of patients treated with preoperative radiation therapy only.

The researchers concluded that survival is similar among patients treated with chemotherapy either preoperatively or postoperatively. However, the addition of chemotherapy to radiation therapy does provide a significant reduction in local recurrences. Patients with operable rectal cancer may wish to speak with their physician regarding their individual risks and benefits of pre- or post-operative chemotherapy.

Reference: Bosset J-F, Collette L, Calais G, et al. Chemotherapy and Preoperative Radiotherapy in Rectal Cancer. New England

Journal of Medicine . 2006; 35:1114-1123.

Related News:Addition of Chemotherapy to Pre-operative Radiation Improves Responses in Rectal Cancer (8/25/2005)

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