What is the best treatment for patients with rectal cancer after chemotherapy, radiation and surgery?

This study compared the effectiveness of oxaliplatin (Eloxatin) with 5-fluorouracil (5-FU Oncofluor, Fluorblastin) as post-surgery treatment for patients with rectal cancer. 

The standard treatment for rectal cancer is chemotherapy and radiation therapy before surgery. The effectiveness of post-surgery chemotherapy is a controversial topic. The National Comprehensive Cancer Network and the European Society for Medical Oncology recommend chemotherapy post-surgery. However the results of some studies have shown no associated benefit in relation to survival without disease or overall survival (time from treatment until death from any cause). The effect of oxaliplatin delivered post-surgically to rectal cancer patients has not yet been widely investigated.

This study aimed to investigate and compare the effects of oxaliplatin and 5-FU delivered post-surgically to rectal cancer patients. The records of 1535 patients were examined. All patients had received chemotherapy and radiation therapy, followed by surgery. Patients were grouped by treatment – no chemotherapy (control group), 5-FU, and oxaliplatin. Survival rates of the three groups were compared.

For patients with stage 1 or stage 2 (cancer has not spread beyond the rectum) cancer, there was no significant difference between the survival rates of patients being treated with 5-FU and patients in the control group. However, stage 3 patients (cancer has spread to the lymph nodes) treated with 5-FU were 1.5 times more likely to have a longer cancer-specific survival (time from treatment until death due to cancer) than were patients in the control group.

There was no significant difference in survival rates between the oxaliplatin and the 5-FU groups. In comparison to the control group, oxaliplatin patients did not have better survival rates.

The authors concluded that the survival of patients with stage 3 rectal cancer already treated with 5-FU chemotherapy is improved by post-surgical treatment with 5-FU chemotherapy. The same effect is not observed when patients are treated with oxaliplatin. 

All patients were aged over 66 years at the time of the study. The findings may not be applicable to patients aged less than 66 years. 

Consult your doctor if you have had rectal surgery and you would like to have chemotherapy.