Long-term results recently reported in the journal Cancer indicate that radiation therapy prior to surgery increases survival for patients with early-stage rectal cancer.

Cancer of the rectum is characterized by the presence of cancer cells in the rectum, approximately the last 10 inches of the colon (or large bowel), a part of the body’s digestive system. Persons who have early-stage rectal cancer (cancer confined to the site of origin) may be cured through the complete surgical removal (resection) of their cancer. Previous clinical trials have demonstrated that pre-operative treatment improves overall survival compared with surgery alone for patients with early-stage rectal cancer.

Researchers from Sweden conducted a clinical trial beginning in 1987 to evaluate pre-operative radiation in over 500 patients with early-stage rectal cancer. Patients in this trial received either radiation to the affected area and surrounding tissues followed by surgery or surgery alone. The rate of a local cancer recurrence for patients able to undergo curative resection was 25% for patients receiving surgery alone compared with only 12% for patients receiving pre-operative radiation therapy. Approximately 9 years following treatment, deaths from rectal cancer occurred in 52% of patients who only received surgery compared with 42% for patients who received pre-operative radiation. However, 18% of patients receiving pre-operative radiation died from complications other than cancer (mainly heart disease) compared with 11% of patients receiving only surgery. These deaths were observed mainly in elderly patients.

These results are consistent with previous data indicating that patients with early-stage rectal cancer may achieve a decrease in local cancer recurrences and a decrease in cancer-related deaths with treatment consisting of pre-operative radiation therapy compared to surgery alone. The increase in cardiovascular deaths in elderly patients receiving radiation therapy may reduce survival benefit for this population of patients. A large, multi-center clinical trial is currently accruing patients to refine optimal scheduling of pre-operative radiation for patients with rectal cancer. Patients with rectal cancer may wish to speak with their physician about the risks and benefits of pre-operative radiation therapy or the participation in a clinical trial further addressing this issue. Two sources of information regarding ongoing clinical trials include comprehensive, easy-to-use listing services provided by the National Cancer Institute (cancer.gov) and eCancerTrials.com. eCancerTrials.com also provides personalized clinical trial searches on behalf of patients. (Cancer, Vol 92, Issue 4, pp 896-902, 2001)

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