Preoperative Chemoradiotherapy Continues to Improve Outcomes for Patients With Rectal Cancer

Pre-treating rectal cancer with chemoradiotherapy once again proved more effective than post-surgery treatment, according to a study published in the Nov. 1, 2009, Journal of Clinical Oncology.

The National Surgical Adjuvant Breast and Bowel Project R-03 (NSABP R-) trial compared neoadjuvant to adjuvant chemoradiotherapy for treating locally advanced rectal carcinoma, said Mark S. Roh et al in the study abstract.

The study involved 267 participants with clinical T3 or T4 or node-positive rectal cancer who were randomly assigned to preoperative or post-operative chemoradiotherapy. Fluorouracil and leucovorin were prescribed, along with 45 Gy in 25 fractions and a 5.40-Gy boost. The preoperative group received surgery within eight weeks of completing treatment. The post-operative group began chemotherapy after recovering from surgery, but no later than four weeks after. Data on the primary endpoints of disease-free survival (DFS) and overall survival (OS) were collected from 254 participants.

Participants who survived were observed for a median of 8.4 years, with a 5-year DFS for preoperative patients of 64 percent versus 53.4 percent for post-operative patients (P = .011). The 5-year OS for preoperative patients was 74 percent versus 66 percent for post-operative patients (P = .065), the researchers stated.

“Preoperative chemoradiotherapy, compared with post-operative chemoradiotherapy, significantly improved DFS and showed a trend toward improved OS,” Roth et al concluded.