Doctors Advise Chemo Before Rectal Cancer Surgery

Link : http://story.news.yahoo.com/news?tmpl=story&cid=571&e=8&u=/nm/health_cancer_dc

BOSTON (Reuters) - Administering chemotherapy and radiation before surgery for rectal cancer may not help patients live longer, but it produces fewer side effects than when it is given afterward, doctors reported on Wednesday

The new finding, published in The New England Journal of Medicine (news - web sites), could translate into less suffering for people with rectal cancer, which affects about 42,000 people in the U.S. each year. Traditionally, doctors have performed surgery first.


"Preoperative chemoradiotherapy is the preferred treatment for patients with locally advanced rectal cancer," said a team led by Rolf Sauer of the University of Erlangen in Germany.


Giving chemotherapy and radiation first may make chemotherapy more tolerable and may shrink the tumor, making it easier to remove with less damage to the rest of the body, they said.


Nearly 800 volunteers and doctors in 26 hospitals were involved in the test, which followed each patient for an average of four years.


The Sauer team found that the five-year survival rate was about 75 percent, whether or not surgery was done first. The rate of complications during surgery was about 35 percent in each group.


But far more people who had their surgery first suffered from side effects when they eventually received their radiation and chemotherapy.


The rate of short-term side effects such as diarrhea was 40 percent among patients who got surgery first, versus 27 percent for those who got it after drug and radiation treatment.


Having surgery after chemoradiation cut the risk of long-term side effects nearly in half.


In an editorial in the Journal, Robert Madoff of the University of Minnesota in Minneapolis said the Sauer team has provided "convincing evidence" that it's better to have surgery last with that type of cancer.


He said evidence has been steadily accumulating from other studies supporting the conclusion of the Sauer group.