More side effects for neoadjuvant therapies

This study compared the functional outcomes of patients treated with surgery alone and chemotherapy or radiotherapy before surgery for rectal cancer.

There are various treatment options for rectal cancer (cancer in the lowest part of the bowel). Some of them may involve use of radiation therapy (RT) or chemo-radiotherapy (CRT – the combination of RT and drugs to kill cancer cells), with or without surgery to remove the cancer. When these therapies are used before surgery, it is called neoadjuvant therapy. Neoadjuvant therapies may help shrink the cancer or kill cancer cells that have begun to spread away from the bowel, thus making easier for the surgeon to remove all the cancer. However, these treatments before surgery may cause additional side effects apart from the surgery itself (such as loss of bowel control, bladder or sexual problems) or may extend the recovery period for patients with rectal cancer. This article aimed to evaluate the functional outcomes of patients treated with surgery alone or with neoadjuvant RT or CRT. 

The study involved 263 patients with rectal cancer treated with surgery between October 2001 and December 2007. Of these patients, 147 received neoadjuvant therapies (91 patients received short-term neoadjuvant RT and 56 patients received neoadjuvant CRT), while 116 received surgery alone. Patients were asked to complete questionnaires which evaluated the rate of fecal incontinence (loss of bowel control), bladder and sexual function.

Results showed that patients who received RT before surgery had a higher risk of developing fecal incontinence (61%) compared to patients who did not receive RT (32%). Regarding bladder function, there was no significant difference between patients treated with surgery alone (51%) and those who received neoadjuvant RT (55%) or CRT (47%). Women tended to experience more frequently bladder problems compared to men. Sexual problems were also more common in patients who received neoadjuvant CRT (76%) or RT (72%) compared to patients treated with surgery alone (61%).

In summary, this study showed that neoadjuvant therapies increase the risk for bowel, bladder and sexual side effects. Therefore, the risks of RT or CRT before surgery need to be balanced against their potential benefits when considering treatment for each patient with rectal cancer. 

Talk to your doctor about the best treatment approach in your situation.