Preoperative radiotherapy is recommended for selected patients with rectal cancer.
Dr Jean-François Bosset and colleagues evaluated chemotherapy with preoperative radiotherapy and the use of postoperative chemotherapy in rectal cancer.
The research team assessed 1011 patients with clinical stage T3 or T4 resectable rectal cancer.
The patients were assigned to receive preoperative radiotherapy, preoperative chemoradiotherapy, and preoperative radiotherapy.
Another group of patients received postoperative chemotherapy, or preoperative chemoradiotherapy and postoperative chemotherapy.
|The 5-year cumulative incidence rate was 8% with pre-and postoperative chemotherapy|
|New England Journal of Medicine|
Radiotherapy consisted of 45 Gy delivered over a period of 5 weeks.
A course of chemotherapy consisted of 350 mg of fluorouracil/m2 of body-surface area per day and 20 mg of leucovorin/m2, both given for 5 days.
The researchers combined 2 courses with preoperative radiotherapy in the group receiving preoperative chemoradiotherapy.
Courses were also combined in the group receiving preoperative chemoradiotherapy and postoperative chemotherapy.
The team planned 4 courses postoperatively in the group receiving preoperative radiotherapy and postoperative chemotherapy.
This was used in the group receiving preoperative chemoradiotherapy and postoperative chemotherapy as well.
The researchers' primary end point was overall survival.
The research team found no significant difference in overall survival between the groups that received chemotherapy preoperatively or postoperatively.
The combined 5-year overall survival rate for all four groups was 65%.
The 5-year cumulative incidence rate for local recurrences were 9% in the group that received chemotherapy preoperatively.
The team noted that the 5-year cumulative incidence rate for those receiving chemotherapy postoperatively was 10%.
When using both preoperative and postoperative chemotherapy, the 5-year cumulative incidence rate was 8%.
The researchers found that the cumulative incidence rate in the group that did not receive chemotherapy was 17%.
The rate of adherence to preoperative chemotherapy was 82%, and to postoperative chemotherapy was 43%.
Dr Bosset's team concludes, “In patients with rectal cancer who receive preoperative radiotherapy, adding fluorouracil-based chemotherapy preoperatively or postoperatively has no significant effect on survival.”
“Chemotherapy, regardless of whether it is administered before or after surgery, confers a significant benefit with respect to local control.”