Pre-surgery chemotherapy and radiation therapy improves the outcomes of locally advanced rectal cancer

This study investigated the benefits of pre-surgery chemotherapy and radiation therapy (CRT) in patients with rectal cancer and pelvic lymph node metastasis (spread of cancer). Researchers suggested that CRT may have a beneficial impact in the disease outcomes of these patients.  

CRT followed by surgery is the standard treatment for patients with locally advanced rectal cancer. Several studies have shown that CRT reduced the local recurrence (when the cancer comes back) rate.

Prior studies have shown that locally advanced rectal cancer spreads to the pelvic lymph nodes in 8-20% of the cases. Pelvic lymph node metastases (PLNM) are treated with CRT followed by rectal surgery without lymph node surgery. Treatment of PLNM differs around the world. In some areas, it is treated with surgery and lymph node removal, without CRT. In other areas, it is treated only with CRT. No studies have compared, so far, the survival outcomes of patients with PLNM treated by lymph node surgery with and without CRT.

The objective of this study was to evaluate the impact of pre-surgery CRT in patients with PLMN.

This study included 73 patients with locally advanced rectal cancer and PLMN who underwent rectal surgery and lymph node surgery. Patients were divided into two groups, patients who received CRT (group 1; 30 patients) and patients who did not (group 2; 43 patients).

In group 1, 5-year overall survival (time from treatment until dath from any cause) was 78.2%. This was significantly longer than group 2 (41.1%). Relapse-free survival (RFS; time from treatment to cancer relapse) was 72.1% in group 1 and 25.4% in group 2. Five-year local recurrence rates were 3.5% in group 1 and 39.6% in group 2. 

The patients in the group 2 were 3.5 times more at risk of a poorer overall survival, 2.7 times more at risk of a worse RFS and 11.1 times more at risk of recurrence.

Four or more PLNM was also a predictive factor for a worse overall survival and RFS.  

This study showed that pre-surgery CRT might have a good impact on patients with locally advanced rectal cancer and PLNM.