How effective is postoperative radiation therapy in the treatment of rectal cancer?

Updated: Apr 06, 2021
  • Author: Burt Cagir, MD, FACS; Chief Editor: N Joseph Espat, MD, MS, FACS  more...
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Answer

A study by Cassidy et al found that elimination of neoadjuvant radiation therapy for select patients with stage II and III rectal adenocarcinoma is associated with worse overall survival. In their review of 21,707 patients with clinical T2N1 (cT2N1), cT3N0, or cT3N1 rectal cancers in the National Cancer Data Base, the 5‐year actuarial overall survival rate was 75% for patients who received neoadjuvant chemoradiotherapy versus 67.2% for those who received neoadjuvant multiagent chemotherapy (P < 0.01). [69]

The advantages of postoperative radiation therapy include immediate definitive resection and accurate pathologic staging information before beginning ionizing radiation. The disadvantages of postoperative radiation therapy include possible delay in adjuvant radiation therapy if postoperative complications ensue; no effect on tumor cell spread at the time of surgery; and the decreased effect of radiation in tissues with surgically-induced hypoxia. Published randomized trials suggest that preoperative or postoperative radiation therapy appears to have a significant impact on local recurrence but does not increase survival rates. [54]

A study by Ng et al found that statin use during and after adjuvant chemotherapy did not result in improved disease-free survival, recurrence-free survival, or overall survival in patients with stage III colon cancer. [70]


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