What are the long-term outcomes of patients with cancer in the rectum and in a limited number of other organs?

This study examined the outcome of patients with rectal cancer that had spread to a limited number of other organs after treatment of the rectal tumor.

Rectal cancer can spread from the rectum to other organs and tissues of the body. This is referred to as metastasis. If the cancer only spreads to a small number of other organs it is referred to as oligometastasis. There are a number of treatment options for rectal cancer patients including surgery, chemotherapy and radiation therapy. It is unclear what the best treatment for rectal cancer patients with oligometastasis is.

This study evaluated the outcome of 26 patients with rectal cancer that had spread to the liver (53.85%), lung (3.85%) or to the liver plus other organs (42.31%). Before undergoing surgery all patients underwent an extended-course of radiation (radiation administered over a few weeks), or chemotherapy plus extended-course radiation. Cancer relapse, overall survival (time until death from any cause) and progression free survival (time until the cancer progresses) were assessed for all patients.

The average patient survival time was 40.5 months. After 12 months the rate of survival was 95% and after 24 months the rate of survival was 70%. The average time till the cancer progressed was 23.1 months. After 12 months the rate of progression was only 9%. However, the cancer had progressed in 64% of patients by 24 months.

After 12 months 9% of patients had local recurrence (return of the cancer at, or near, the original cancer site) and after 24 months 34% of patients of patients had local recurrence. No patients had metastatic recurrence (return of the cancer at a distant site) after 12 months, but by 24 months 61% had cancer relapse at a distant site.

The authors concluded that the rate of survival after 2 years was good, but the rate of local recurrence was high despite surgery and chemoradiation. They suggest that a short-course of radiation (a higher dose delivered in 5 sessions over one week, with surgery soon after) may reduce the local recurrence rates.

This study was carried out in only one hospital and only included 26 patients. Further research is needed to ensure the accuracy of these results and to determine if a short course of radiation would reduce local recurrence.