Chemotherapy before surgery in the treatment of high risk rectal cancer

This study investigated the outcomes of chemotherapy before surgery in patients with high-risk rectal cancer. Researchers suggested that chemotherapy improves tumor shrinkage before rectal surgery.  

The standard treatment for patients with rectal cancer is surgery. High-risk patients may benefit from short-course radiation therapy before surgery. This treatment reduces local recurrence (when cancer comes back to the same place) by 5%. However, this has not improved the risk of cancer spreading to other parts of the body (metastasis). For patients at risk for metastasis, chemotherapy is given after surgery. However, it remains unknown if chemotherapy before surgery might allow an earlier treatment of early metastasis.

This study included 57 patients with high-risk rectal cancer. All patients underwent chemotherapy for 8 weeks followed by 5 days of radiation therapy, followed by surgery. 6 to 8 weeks after surgery, patients underwent another course of chemotherapy. The average follow-up time was 27 months.

Side effects associated with chemotherapy (both before and after surgery) were manageable. There were no treatment-related deaths. The most common side effects of chemotherapy were low white blood cell counts (20% before surgery and 11% after surgery).

Nine weeks following chemotherapy before surgery, 73% of the tumors achieved shrinkage. The 2-year progression-free survival (time from treatment to disease progression) was 86.2%.

This study showed that patients with high-risk rectal cancer may benefit from chemotherapy treatment before surgery.

This study had a small patient population. Also, there was no comparison group of patients who did not have chemotherapy before surgery. Further larger studies are needed to confirm these results.