Radiation, chemotherapy before surgery controls rectal cancer
Main Category: Radiology / Nuclear MedicineArticle Date: 18 Oct 2005 - 0:00 PDT
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For patients with rectal cancer, receiving radiation therapy and chemotherapy before surgery to shrink the tumor so it can be more easily removed helps keep the cancer from coming back, according to a study presented October 17, 2005, at the American Society for Therapeutic Radiology and Oncology's 47th Annual Meeting in Denver.
Beginning in 1992, doctors in France enrolled 733 patients suffering from rectal cancer into the study. The patients were split into two groups - the first received radiation alone for five weeks before undergoing surgery to remove the cancer. The second group received chemotherapy in addition to five weeks of radiation therapy prior to surgery.
"The standard treatment for rectal cancer has been radiation therapy alone before surgery, but this is the first randomized study to prove that adding chemotherapy to the treatment helps patients beat their cancer," said Pascale Romestaing, M.D., co-author of the study and a radiation oncologist at CHU Lyon Sud in Lyon, France.
The doctors discovered that while combining radiation therapy and chemotherapy does not significantly increase survival rates, it does improve local tumor control and helps to keep the cancer from returning. The last phase of the trial, from 1999 to 2003, showed that only eight percent of the patients saw their cancer return five years after receiving treatment.
"This treatment should be recommended as the standard for the majority of rectal cancer patients," said Jean-Pierre Gerard, M.D., lead author of the study and a radiation oncologist at the Centre Antoine-Lacassagne in Nice, France.
ASTRO is the largest radiation oncology society in the world, with more than 8,000 members who specialize in treating patients with radiation therapies. As a leading organization in radiation oncology, biology and physics, the Society is dedicated to the advancement of the practice of radiation oncology by promoting excellence in patient care, providing opportunities for educational and professional development, promoting research and disseminating research results and representing radiation oncology in a rapidly evolving socioeconomic healthcare environment.
Beth Bukata
bethb@astro.org
American Society for Therapeutic Radiology and Oncology
http://www.astro.org
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Research Before You Leap
posted by Gregory D. Pawelski on 18 Oct 2005 at 7:41 amAmerican Society of Clinical Oncology recommendations on adjuvant chemotherapy for stage II colorectal cancer.
Benson AB 3rd, Schrag D, Somerfield MR, Cohen AM, Figueredo AT, Flynn PJ, Krzyzanowska MK, Maroun J, McAllister P, Van Cutsem E, Brouwers M, Charette M, Haller DG. American Society of Clinical Oncology, Alexandria, VA 22314, USA.
PURPOSE: To address whether all medically fit patients with curatively resected stage II colorectal cancer should be offered adjuvant chemotherapy as part of routine clinical practice, to identify patients with poor prognosis characteristics, and to describe strategies for oncologists to use to discuss adjuvant chemotherapy in practice.
METHODS: An American Society of Clinical Oncology Panel, in collaboration with the Cancer Care Ontario Practice Guideline Initiative, reviewed pertinent information from the literature through May 2003.
RESULTS: A literature-based meta-analysis found NO evidence of a statistically significant survival benefit of adjuvant chemotherapy for stage II patients.
RECOMMENDATIONS: The routine use of adjuvant chemotherapy for medically fit patients with stage II colorectal cancer is not recommended. However, there are populations of patients with stage II disease that could be considered for adjuvant therapy, including patients with inadequately sampled nodes, T4 lesions, perforation, or poorly differentiated histology.
CONCLUSION: Direct evidence from randomized controlled trials does not support the routine use of adjuvant chemotherapy for patients with stage II colorectal cancer. Patients and oncologists who accept the relative benefit in stage III disease as adequate indirect evidence of benefit for stage II disease are justified in considering the use of adjuvant chemotherapy, particularly for those patients with high-risk stage II disease. The ultimate clinical decision should be based on discussions with the patient about the nature of the evidence supporting treatment, the anticipated morbidity of treatment, the presence of high-risk prognostic features on individual prognosis, and patient preferences.
J Clin Oncol. 2004 Aug 15;22(16):3408-19.
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