The results of a recent study published in the New England Journal of Medicine indicate that pre-operative chemoradiotherapy for rectal cancer improved local disease control with reduced toxicity, but did not improve overall survival.
Each year in the United States, approximately 140,000 new cases of colorectal cancer are diagnosed. One-third of these cancers originate in the rectum, which is the final 6 inches of the large intestine. Current treatment for locally advanced rectal cancer consists of surgery followed by chemotherapy and radiation given concurrently (chemoradiotherapy). In the post-operative period, chemotherapy and radiation for rectal cancer are often associated with moderate to severe side effects. This has lead to increased research of pre-operative chemoradiotherapy for patients diagnosed with locally advanced rectal cancer.
In this multi-center trial, 823 patients diagnosed with locally advanced rectal cancer (cancer that had spread to the surrounding lymph nodes) were randomly assigned to receive either pre-operative (421) or post-operative (402) chemoradiotherapy. Patients enrolled in the pre-operative arm of the study received radiation 5 days a week for 5 weeks, along with fluorouracil chemotherapy at 1000mg per day during the first and fifth weeks. These patients then underwent surgery 6 weeks after chemoradiotherapy was complete. In the post-operative group, patients were treated with chemoradiotherapy one month after surgery patients; the regimen consisted of four, 5-day cycles of fluorouracil at 500mg per day, along with the same dose of radiation, and an additional boost of radiation.
Results of this study indicate that the 5-year survival rate for patients in the pre-operative group was 76%, compared to 74% for patients in the post-operative group. The 5-year incidence of local relapse was 6% for the pre-operative patients and 13% in the post-operative treatment group. Moderate to severe side effects occurred in 27% of the pre-operatively treated group, compared to 40% of the patients in the post-operative treatment group. Long-term side effects affected 14% of the pre-operative group, compared to 24% of the post-operative group.
Researchers concluded that pre-operative chemoradiotherapy improved local control and was associated with less toxicity than post-operative chemoradiotherapy, although it did not improve overall survival. Patients are encouraged to speak to their physician regarding treatment options.
Reference: Sauer R, Becker H, Hoenberger W, et al. Preoperative versus Postoperative Chemoradiotherapy for Rectal Cancer. New England Journal of Medicine. 2004; 351: 1731-1740.
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