Radiation Before Rectal Cancer Surgery Reduces Cancer Recurrence and Quality of Life: Presented at ASTRO

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Title: Radiation Before Rectal Cancer Surgery Reduces Cancer Recurrence and Quality of Life: Presented at ASTRO
URL: http://www.pslgroup.com/dg/22DA32.htm
Doctor's Guide
September 26, 2008

By Martha Kerr, BSN

BOSTON -- September 26, 2008 -- A short, 1-week course of radiation reduces risk of recurrence of rectal cancer, but it can also lower quality of life due to decreased sexual function in men and to a loss of bowel control, researchers reported here at the American Society for Therapeutic Radiology and Oncology (ASTRO) 50th Annual Meeting.

Risk of relapse is high with surgery alone for rectal cancer, noted principal investigator David Sebag-Montefiore, MD, St. James's Institute of Oncology, St. James's University Hospital, Leeds, United Kingdom.

Dr. Sebag-Montefiore presented the study on September 24.

The investigators randomised 1,350 patients to short-course (1 week) preoperative radiotherapy using 25 Gy, or surgery followed by selective postoperative chemo-radiotherapy. Patients in the postoperative group who were at high risk of a local recurrence received chemotherapy plus 25 treatments of radiotherapy (45 Gy) daily over 5 weeks after surgery.

Only 4% of patients in the preoperative group had local cancer recurrence at 3-year follow-up compared with 11% of patients the postoperative radiotherapy group. The survival rate at 3 years was 78% in the preoperative group and 72% in the postoperative group, the investigators found in another analysis of the data.

In this quality-of-life assessment, preoperative radiation, Dr. Sebag-Montefiore said, "did negatively affect male sexual function ... and this difference continued out to 3 years."

"Male sexual function was worse after an abdominoperineal excision compared with an anterior resection," he said.

Preoperative radiotherapy resulted in "a modest detrimental effect on faecal continence," the Leeds investigator added.

For unintentional release of stools, the proportion of patients reporting this to be "quite a bit" or "very much" was 16.4% in the preoperative group compared with 6.5% in the postoperative group at 18 months (P = .003). At 24 months, the rates were 11.7% in the preoperative group compared with 6.6% in the postoperative group (P = .12).

Patients in both treatment arms reported decreased physical functioning at 3 months, but returned to baseline levels after recovery. General health appeared relatively good in both treatment arms at that time.

"We know that this and other trials have consistently shown that radiation before surgery reduces the risk of local cancer returning, however, this has to be balanced against any negative side effects," Dr. Sebag-Montefiore said. "The results of our quality of life study should help doctors and patients to discuss both the benefits and risks of preoperative radiation before surgical removal of rectal cancer."

Dr. Sebag-Montefiore had no financial conflicts of interest to declare.

[Presentation title: The Impact of Short Course Pre-Operative Radiotherapy on Patients' Quality of Life: Data From the MRC. Abstract 61]

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