According to an article recently published in the Journal of Clinical Oncology, radiation therapy following surgery delivered early in the course of treatment appears to prolong disease-free survival compared to radiation delivered later in patients with stages II and III rectal cancer.

The rectum is the last 8-10 inches of the large intestine. Stage II rectal cancer refers to cancer that has penetrated the wall of the rectum, but cannot be detected in local lymph nodes or elsewhere in the body. Stage III rectal cancer refers to cancer that has penetrated the wall of the rectum and has invaded local lymph nodes ,but cannot be detected in distant sites of the body. Standard treatment for stages II and III rectal cancer typically involves surgery and often results in apparent curative resection (surgical removal of all evident cancer). Despite apparent curative surgery, small amounts of undetectable cancer cells may remain following surgery. These cancer cells are responsible for cancer recurrences. Therefore, chemotherapy and/or radiation therapy are usually offered to patients following surgery in an attempt to kill any remaining cancer cells and ultimately improve survival. However, the exact therapeutic regimen following a curative resection for patients with stages II and III rectal cancer is not agreed upon by all physicians and clinical trials are ongoing in an attempt to determine the most effective approach.

Researchers from Korea recently conducted a clinical trial to evaluate the timing of the delivery of radiation therapy in patients with stage II and III rectal cancer following a surgical resection. This trial involved 308 patients, all of whom received chemotherapy consisting of 5-fluorouracil (5-FU) and leucovorin (LV) (eight cycles at four week intervals) following surgery. Patients were divided into two groups: 155 received radiation to the pelvis starting on the first day of the first chemotherapy cycle and 153 received radiation to the pelvis on the first day of the third chemotherapy cycle. Approximately three years following therapy, cancer recurred in 19% of patients treated with early radiation, compared with 30% treated with late radiation. Overall survival was not significantly different between the two groups.

These results indicate that chemotherapy plus early radiation therapy appears to reduce cancer recurrences compared to chemotherapy plus late radiation therapy in patients with resected stage II and III rectal cancer. Longer follow-up may demonstrate an improved survival in the group of patients treated with early radiation, as cancer recurrences were reduced. Patients with stage II or III rectal cancer may wish to speak with their physician about the risks and benefits of early radiation in combination with chemotherapy following surgery or the participation in a clinical trial evaluating novel therapeutic approaches. Two sources of information regarding ongoing clinical trials include comprehensive, easy-to-use listing services provided by the National Cancer Institute (cancer.gov) and www.eCancerTrials.com eCancerTrials.com also provides personalized clinical trial searches on behalf of patients.

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Reference: Lee J-H, Lee J-H, Ahn J-H, et al. Randomized trial of postoperative adjuvant therapy in stage II and III rectal cancer to define the optimal sequence of chemotherapy and radiotherapy: A preliminary report. Journal of Clinical Oncology. 2002;20:1751-1758.

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