NEW YORK (Reuters Health), Sep 14 - As an adjunct to preoperative radiotherapy, fluorouracil-based chemotherapy, given either before or after surgery, improves the local control of rectal cancer, new research shows. However, adding chemotherapy does not improve survival.
The findings, which appear in The New England Journal of Medicine for September 14, come from a study of 1,011 patients with stage T3 or T4 resectable rectal cancer who were randomized to receive preoperative radiotherapy, preoperative chemoradiotherapy, preoperative radiotherapy and postoperative chemotherapy, or preoperative chemoradiotherapy and postoperative chemotherapy.
Giving chemotherapy either before or after surgery had no significant effect on overall survival, lead author Dr. Jean-Francois Bosset, from Besancon University Hospital in France, and colleagues report. The combined 5-year overall survival rate for the four study groups was 65.2%.
By contrast, chemotherapy use did seem to improve local control. For the groups that received chemotherapy before surgery, after surgery, or both, the local recurrence rates were 8.7%, 9.6%, and 7.5%, respectively. Without chemotherapy, however, the rate was 17.1% (p = 0.002).
The adherence rates for preoperative and postoperative chemotherapy were 82.0% and 42.9%, respectively, the investigators found.
"Given the high rate of local control obtained with preoperative chemoradiotherapy and the lack of effect on survival, it seems unnecessary to intensify this regimen in an attempt to further decrease local recurrences or to prevent metastases," the researchers conclude.
"The role of postoperative chemotherapy is not yet defined and adherence to it is poor. We believe, therefore, that preoperative chemotherapy is an option worth considering for some patients," they add.
Last Updated: 2006-09-13 17:00:06 -0400 (Reuters Health)
N Engl J Med 2006;355:1114-1123.
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