Is chemotherapy, chemoradiation and surgery a recipe for remission?

This study looked at the survival of patients with advanced rectal cancer when treated with chemotherapy either before or after chemoradiation and surgery.

A common treatment option for rectal cancer is a combination of chemotherapy and radiation therapy (chemoradiation) followed by surgery. Further chemotherapy is then often recommended. Many patients, however, do not fully comply with the post-surgery chemotherapy, due to side effects.

Chemotherapy treatment can also be given before chemoradiation and surgery. This treatment option leads to similar tumor response (such as tumor shrinkage) and less severe side effects. The long-term outcomes, such as recurrence and survival rates, are not yet known.

This study examined whether chemotherapy treatment before chemoradiation and surgery was as effective in the long-term as chemotherapy following surgery.

108 patients with locally advanced rectal cancer (cancer that has spread through the bowel wall) were randomly assigned to one of two treatment groups. Group A underwent chemotherapy after chemoradiation and surgery. Group B underwent chemotherapy before chemoradiation and surgery. Patients were followed for an average of 69 months.

Group A had a 2% local recurrence (cancer return at the same site) rate and a 21% distant recurrence (cancer return at a distant site) rate. The local recurrence rate was 5% and the distant recurrence rate was 23% in Group B.

Five-year disease free survival (time from treatment until the disease progression) was 64% for Group A and 62% for Group B. After 5 years, 78% of the patients in Group A were still alive, and 75% of Group B. 

This study concluded that chemotherapy prior to chemoradiation and surgery offered similar long-term outcomes to chemotherapy following surgery.

Further trials are required to fully compare this treatment suggestion to currently used treatments.

Discuss this treatment strategy for rectal cancer with your doctor.