Benefits of Pre-Surgery Chemoradiation for Rectal Cancer

Pre-surgical treatment reduces local but not distant recurrence

A study published in the New England Journal of Medicine found that patients with stage 2 or stage 3 rectal cancer who received chemotherapy and radiation before surgery were less likely to have a recurrence than patients who received chemo and radiation after surgery.

Man receiving chemotherapy
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Researchers studied more than 800 patients with stage 2 and stage 3 rectal cancer. About half received chemo and radiation (chemoradiation) before surgery and the other half received chemoradiation after surgery. A patient follow-up four years after treatment found a clear benefit for the before-surgery group.

Study Shows Less Local Recurrence

Specifically, 6% of patients who received chemoradiation before surgery had a local recurrence, versus 13% of patients who received chemoradiation after surgery. Patients in the before-surgery group also experienced fewer side effects from treatment, like diarrhea and narrowing of the bowel where it had been reconnected after the tumor was removed. It allowed an increased rate of sphincter preservation in patients with low-lying tumors. The researchers also didn't see increased tumor progression in delaying surgery for the 12 weeks of pre-treatment and recovery in that group.

The treatment given was radiotherapy five times per week for a total of 5.5 weeks. The chemotherapy given was fluorouracil during the first and fifth weeks of radiotherapy. For the pre-operative treatment group, the surgery was scheduled for six weeks after the completion of the treatment. Both groups received a further four cycles of fluorouracil after surgery.

No Difference in Distant Recurrence Rates and Overall Survival

Although the timing of treatment made a difference for side effects and local recurrence rates, it didn't seem to make a difference when it came to overall survival or the chance that cancer would spread to a different part of the body. The distant recurrence rate was the same for both groups.

What This Means for You

If you're about to receive surgery for stage 2 or stage 3 rectal cancer, it is now standard to receive chemotherapy and radiation before surgery rather than after. Thanks to this research, doing so could halve your chances of a local recurrence and improve your overall quality of life during and after treatment.

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  1. Sauer R, Becker H, Hohenberger W, et al. Preoperative versus postoperative chemoradiotherapy for rectal cancer. N Engl J Med. 2004;351(17):1731-1740. doi:10.1056/NEJMoa040694

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