Does your treatment choice after surgery really matter?

This study looked at the impact of two treatments, chemoradiotherapy and chemotherapy, on the survival of patients with rectal cancer and on the return of their cancer.

Normally, prior to surgery to remove rectal cancer, a combination of chemotherapy and radiotherapy is given. Chemotherapy uses a drug or combination of drugs to kill cancer cells. Radiotherapy uses high-energy radiation to kill cancer cells by damaging their DNA.

The usefulness of chemo-radiotherapy combination after surgery has not been thoroughly researched. It is also not clear whether it is more effective than chemotherapy alone.

190 patients with stage 2 or 3 adenocarcinoma (spread through the walls of the rectum or to the lymph nodes) of the rectum were included in this study. None of the patients received any treatment before their surgery. Following surgery, 30% of patients received both chemotherapy and radiotherapy for six months. The remaining 70% received chemotherapy alone. Patients were followed for an average of 70 months.

No significant differences were found between the two groups in terms of how well the treatments controlled their cancer. Close to 87% of the patients receiving chemo-radiotherapy were alive at 5 years, compared to almost 83% of patients who received chemotherapy alone.

There were no differences in 5-year local control (cancer is not progressing at the original site) for patients with low-risk disease (for example, those with small, localized tumors). In high-risk patients (those with larger, more advanced tumors), chemo-radiotherapy improved 5-year local control (96.4% of patients) compared to chemotherapy (70.7% of patients).

Patients included in this study had a range of backgrounds (such as age, cancer stage, etc.). When a subset of patients in each group with similar backgrounds were compared, 89.9% of those who received chemo-radiotherapy were still alive at the 5-year mark compared to 69.8% of patients treated with chemotherapy. Cancer had not progressed past its original site in 98% of patients on chemo-radiotherapy vs 85.2% of radiotherapy patients.

The authors concluded that chemo-radiotherapy following surgery was linked with slower spread of cancer and better survival rates for patients with either stage 2 or 3 rectal cancer. They also concluded that chemotherapy may be given alone but only in patients with low-risk disease.

This study included a small number of patients and should be repeated on a larger level.

Discuss this article with your doctor to determine which treatment option is best for you.