Chemotherapy and radiation therapy in lower third rectal cancer

This study investigated the outcomes of lower third rectal cancer patients treated with chemotherapy and radiation therapy (CRT). Researchers suggested that CRT could be beneficial for lower rectal cancer patients. 

The most adequate treatment for lower rectal cancer is still a challenge. Prior studies suggested that surgery following CRT could improve disease control with less toxicity when compared to surgery followed by CRT. Surgery following CRT was adopted as the standard treatment of stage 2 and stage 3 rectal cancers. However, radiotherapy has been shown to have a high toxicity in these patients. Intensity modulated radiation therapy (IMRT) showed lower rates of toxicity and high tumor response rates when combined with the chemotherapy fluoropyrimidine after rectal surgery. The outcomes of this treatment combination in patients with lower rectal cancer are still unclear. 

The objective of this study was to investigate the outcomes of lower third rectal cancer patients who underwent CRT after rectal surgery.

This study includes information about 69 rectal cancer patients who underwent CRT followed by surgery (35 patients-group 1) or surgery followed by CRT (34 patients- group 2). The patients in group 1 underwent IMRT and fluoropyrimidine as CRT treatment.

The average follow-up period was 67 months. In group 1, 5-year overall survival (OS; time from treatment to death by any cause) was 70%. 5- year disease-free survival (DFS; time from treatment to disease progression) was 70%. The local recurrence (LR; the cancer returns at the original site) rate was 3%.

Patients in group 2 had a 5-year OS of 51%, 5-year DFS of 45% and an LR of 25%. The 5-year sphincter (muscle that enables bowel natural movement) sparing rate was increased from 38.2% to 100% from group 2 to group 1.   

This study reported that patients with lower third rectal cancer could benefit from CRT followed by surgery.