Is longer post-surgery chemotherapy helpful in locally advanced rectal cancer?

This study evaluated the impact of different durations of post-surgery chemotherapy in the treatment of locally advanced (spread to the lymph nodes) rectal cancer patients.

Researchers suggested that longer post-surgery chemotherapy for stage 3 patients was associated with lower metastasis (spread to other parts of the body) rates and longer disease-free survival.

Currently, the normal treatment for locally advanced rectal cancer is chemotherapy combined with radiation therapy followed by surgery. After surgery it is recommended to undergo four months of chemotherapy. However, less than 50% of patients finish the treatment due to side effects. Prior studies have also shown that post-surgery chemotherapy in stage 2 rectal cancer patients may not be necessary, due to the high rates of survival of these patients regardless of receiving chemotherapy.

The objective of this study was to evaluate whether a shorter duration of post-surgery chemotherapy should be recommended for patients with stage 2-3 rectal cancer.

This study included information on 200 stage 2-3 rectal cancer patients treated with presurgery chemotherapy and radiation therapy. The patients were divided in two groups: those who received less than 2 months of post-surgery chemotherapy and those that received more than 2 months of chemotherapy.

Overall survival (OS; time from beginning the trial to death from any cause) and disease-free survival (DFS; time from after treatment during which no disease is found) were compared between the two groups.

For patients with stage 2 cancer, 5-year OS was 81.6% and DFS was 75% following the long duration of chemotherapy. Following the short duration, the 5-year OS was 84.1% and DFS was 71.8%. These differences were not significant.

For patients with stage 3 cancer, 5-year DFS was 65.4% following the long duration of chemotherapy. This was significantly longer than following the short duration (35.9%). No significant difference was seen in OS between short and long treatment groups.

Patients who underwent long duration chemotherapy had a lower rate of metastasis.

This study determined that longer post-surgery chemotherapy is necessary for patients with stage 3 rectal cancer, but may not be necessary for stage 2 patients. Longer post-surgery chemotherapy is associated with low rates of metastasis.

Discuss with your doctor the risks and benefits of post-sugery chemotherapy.