מתוך medicontext.co.il
LONDON (Reuters Health) – Rectal cancer patients who undergo preoperative radiotherapy are less likely to experience a local recurrence and less likely to die from their disease than patients who do not undergo this adjuvant therapy, according to a report published in the October 20th issue of The Lancet.
Dr. Richard Gray, from the University of Birmingham in the UK, and colleagues performed a meta-analysis of 22 randomised trials that assessed the benefits of adjuvant radiotherapy for rectal cancer. The trials included a total of 8507 patients.
The researchers found that overall survival was only slightly improved when adjuvant radiotherapy was employed. Furthermore, use of preoperative radiotherapy did not influence the curative resection rate.
Adjuvant radiotherapy use did, however, reduce the local recurrence risk, the authors note. Patients who underwent preoperative radiotherapy had a yearly local recurrence risk that was 46% lower than patients who underwent surgery alone. Postoperative radiotherapy use was linked to a 37% lower risk compared with surgery alone.
Patients who underwent preoperative radiotherapy were less likely to die from their disease than patients who underwent surgery alone (p = 0.0003). However, within 1 year of treatment, deaths from other causes were more common among radiotherapy-treated patients.
The current findings differ from those of a study presented last week at the 87th Clinical Congress of the American College of Surgeons in New Orleans (see Reuters Health report, October 15). In that study, use of preoperative radiotherapy did not influence local recurrence rate, but it was tied to an improvement in 5-year survival.
Dr. Gray's team believes that overall survival could be moderately improved if the safety of preoperative radiotherapy could be improved without compromising its effectiveness. It is also possible that outcomes could be further improved through the use of systemic chemotherapy, a modality used in only a few of the trials reviewed.
In a related editorial, Dr. Bruce D. Minsky, from Memorial Sloan Kettering Cancer Center in New York, comments that while the current results support the use of adjuvant radiotherapy for rectal cancer, uncertainties remain.
"The uncertainties are the time of the radiotherapy, the regimens (short intensive course or conventional course), and the value of concurrent chemotherapy," Dr. Minsky notes. "Randomised trials should provide a definitive answer to these issues within the next few years," he adds.
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