According to results recently published in the International Journal of Radiation Oncology, Biology and Physics, the addition of chemotherapy to radiation therapy prior to surgery improves anti-cancer responses and helps to preserve sphincter control in patients with rectal cancer.

The rectum is the last 8 to 10 inches of the large intestine. Locally advanced rectal cancer refers to cancer that has spread locally from its site of origin, but not to distant sites in the body. Standard therapy for locally advanced rectal cancer often consists of the surgical removal of the cancer, chemotherapy and/or radiation therapy. The precise roles and timing of chemotherapy and/or radiation therapy are currently under debate, as results from clinical trials have not provided definitive conclusions.

One type of therapeutic approach that is gaining momentum in the treatment of rectal cancer is neoadjuvant therapy, or therapy prior to surgery. The concept behind the use of neoadjuvant therapy is two-fold. One reason for neoadjuvant therapy is to shrink the cancer so that complete surgical removal may become possible. A second reason is to kill the cancer cells that have spread in the body as quickly as possible, prior to further growth, which can occur while a patient is waiting to recover from surgery. Furthermore, a complication that can occur from the surgical removal of rectal cancer is the damaging of the sphincter, a circular muscle that controls defecation. This surgical complication can leave patients unable to control bowel movements for the remainder of their lives. Neoadjuvant therapy can help minimize the extent of surgery through shrinking the cancer, and thus minimize the risk of sphincter damage. Although neoadjuvant radiation therapy has recently been studied in the treatment of rectal cancer, results from trials evaluating the combination of both chemotherapy and radiation therapy administered prior to surgery remain limited.

One type of therapeutic approach that is gaining momentum in the treatment of rectal cancer is neoadjuvant therapy, or therapy prior to surgery. The concept behind the use of neoadjuvant therapy is two-fold. One reason for neoadjuvant therapy is to shrink the cancer so that complete surgical removal may become possible. A second reason is to kill the cancer cells that have spread in the body as quickly as possible, prior to further growth, which can occur while a patient is waiting to recover from surgery. Furthermore, a complication that can occur from the surgical removal of rectal cancer is the damaging of the sphincter, a circular muscle that controls defecation. This surgical complication can leave patients unable to control bowel movements for the remainder of their lives. Neoadjuvant therapy can help minimize the extent of surgery through shrinking the cancer, and thus minimize the risk of sphincter damage. Although neoadjuvant radiation therapy has recently been studied in the treatment of rectal cancer, results from trials evaluating the combination of both chemotherapy and radiation therapy administered prior to surgery remain limited.

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Recently, researchers evaluated data including patients with locally advanced rectal cancer who were treated with neoadjuvant therapy. This study included the review of hospital records from 403 patients who were treated by specialists between 1978 and 995 at the MD Anderson Cancer Center and Washington University School of Medicine. All patients were treated with neoadjuvant radiation therapy, and 215 of these patients were treated with neoadjuvant chemotherapy consisting of 5-fluorouracil, in addition to the radiation. At approximately 5 years following therapy, anti-cancer responses and sphincter preservation were significantly improved in patients who were treated with neoadjuvant chemotherapy plus radiation therapy, compared to those treated with neoadjuvant radiation therapy only. Sphincter preservation was improved by over 30% in patients treated with neoadjuvant chemotherapy, compared to those treated with radiation only. However, the rate of recurrences and overall survival did not appear to be affected by the addition of chemotherapy.

The researchers concluded that sphincter preservation might be significantly improved due to enhanced anti-cancer responses with the addition of chemotherapy to radiation therapy as neoadjuvant treatment for rectal cancer. Patients with rectal cancer who are considering neoadjuvant therapy may wish to discuss the risks and benefits of the combination of chemotherapy and radiation therapy prior to surgery or the participation in a clinical trial evaluating novel therapeutic approaches with their physician. Two sources of information regarding ongoing clinical trials include the National Cancer Institute (cancer.gov) and www.cancerconsultants.com. Personalized clinical trial searches are also performed on behalf of cancerconsultants.com.

Reference: Crane C, Skibber J, Birnbaum E, et al. The addition of continuous infusion 5-FU to preoperative radiation therapy increases tumor response, leading to increased sphincter preservation in locally advanced rectal cancer.

International Journal of Radiation, Biology, Physics. 2003;57:84-89.

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