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Neoadjuvant Chemoradiation for Rectal Cancer

Neoadjuvant chemoradiation is superior to adjuvant therapies for locally advanced rectal cancer.

Total mesorectal excision decreases rectal cancer recurrence rates compared with traditional blunt-dissection techniques. In addition, neoadjuvant chemoradiation for stage T3 and T4 rectal cancers has emerged as an important contributor to control local recurrences after surgical resection.

In this European study, researchers compared the effects of pre- and postoperative chemotherapy in 1011 patients with stage T3 or T4 resectable rectal cancer. Patients were randomized to receive:

• preoperative radiotherapy only
  
• preoperative radiotherapy and chemotherapy
  
• preoperative radiotherapy plus postoperative chemotherapy
  
• preoperative radiotherapy and chemotherapy plus postoperative chemotherapy
  

Five-year survival rates were similar in all groups (about 65%). The 5-year cumulative incidence rates of local recurrence were 8.7% in the group who received preoperative chemoradiotherapy, 9.6% in the group who received preoperative radiotherapy plus postoperative chemotherapy, and 7.6% in the group who received preoperative chemoradiotherapy plus postoperative chemotherapy; local-recurrence incidence was 17.1% in the group that did not receive any chemotherapy (P=0.002). Adherence rates for preoperative and postoperative chemotherapy were 82% and 43%, respectively.

Comment: These findings suggest that patients are more likely to adhere to chemotherapy when it is given preoperatively, and we know that the toxicity of preoperative radiotherapy is less than that of postoperative radiotherapy. This study helps to confirm that neoadjuvant chemoradiation is superior to adjuvant therapies for locally advanced rectal cancer.

— Douglas K. Rex, MD

Published in Journal Watch Gastroenterology November 9, 2006

Citation(s):

Bosset JF et al. Chemotherapy with preoperative radiotherapy in rectal cancer. N Engl J Med 2006 Sep 14; 355:1114-23.

• Original article (Subscription may be required)
• Medline abstract (Free)