What are the long-term effects of newer chemoradiotherapy techniques in rectal cancer?

This study looked at the safety and effectiveness of a type of chemoradiotherapy following surgery for rectal cancer.

Radiation therapy uses high-energy radiation to kill cancer cells by damaging their DNA.
Advanced radiation treatments such as three-dimensional conformal radiotherapy (3D-CRT) and intensity-modulated radiotherapy (IMRT) have been shown to better distribute the dose of radiation and better protect normal tissue.

Currently chemoradiotherapy with a drug, 5-fluorouracil, is recommended for patients with stages 2 and 3 rectal cancer. A new drug, capecitabine (Xeloda), may be as effective while having less side effects.

The long-term effects of chemoradiotherapy using 3D-CRT/IMRT  combined with capecitabine are not known.

The records of 184 patients diagnosed with stage 2 or 3 rectal cancer were examined in this study. These patients had been treated with chemoradiotherapy with either the IMRT (133 patients) or 3D-CRT (51 patients) technique. Almost 65% of patients had high-risk stage 2 or 3 disease. These patients were given additional chemotherapy.

Response to treatment was measured every week during treatment and every 3-6 months for 3-5 years. The average follow-up time was 47 months. At this stage, 85% of patients were still alive. 

The 5-year disease-free survival rate (the length of time after primary treatment for a cancer ends that the patient survives without any signs or symptoms of that cancer) was 80%.

95.4% of patients’ cancers were restricted to their original site following treatment. Moreover, patients with cancer that had spread to their lymph nodes were less likely to do well following treatment.

One of the most common side effects of treatment was diarrhea (22.8% of patients). Other side effects included low levels of white blood cells (the cells that help fight infection, 3.8%) and skin infections (2.2%). Following these side effects, 4.9% of patients discontinued radiotherapy and 6% chemotherapy. Most of these patients resumed treatment once they felt better.

The authors found that patients with stage 2 and 3 rectal cancer can be treated safely and effectively by chemoradiotherapy with capecitabine and IMRT/3D-CRT following surgery.

Discuss with your doctor whether chemoradiotherapy is a treatment option for you.