Preoperative radiotherapy reduces risk of local recurrence and death from rectal cancer, conclude authors of a systematic overview published in this week’s issue of The Lancet.
There are different opinions about when it is best to give radiotherapy for rectal cancer. In Scandinavia, the Netherlands, and some other European countries, radiotherapy is usually given before an operation to remove the cancer, whereas in the UK and North America, radiotherapy is usually given after the operation. An analysis of data from 8507 patients in 22 trials of radiotherapy treatment before or after surgery for cancer of the rectum (lower bowel) by the Colorectal Cancer Collaborative Group suggests that radiotherapy before surgery is preferable.
"We found there were about half as many local recurrences in those who had preoperative radiotherapy compared to those who had surgery alone. In those who had postoperative radiotherapy, local recurrences were reduced by a third." said Richard Gray from the University of Birmingham, UK, one of the organisers of the study. "We also found that fewer patients who had preoperative radiotherapy died from rectal cancer than did those who had surgery alone (45% vs 50%) but early deaths from other causes increased."
In an accompanying Commentary (p1285), Bruce D Minsky, from The Sloan Kettering Cancer Centre in New York, USA, cautions that the results "… give support to adjuvant radiotherapy for rectal cancer. The uncertainties are the timing of the radiotherapy, the regimens…and the value of concurrent chemotherapy."
Contacts: Professor Richard Gray, University of Birmingham Clinical Trials Unit, Park Grange, 1 Somerset Road, Edgbaston, Birmingham B15 2RR, UK, T) +44 (0)121 687 2310; Mobile) +44 (0)7768 696407; F) +44 (0) 121 687 2313. E )r.gray@bham.ac.uk
Dr Bruce D Minsky, Department of Radiation Oncology, Sloan Kettering Cancer Centre, New York, USA. E) minskyb@mmkee.org
Journal
The Lancet