Surgery, with or without radiation therapy, remains the gold-standard treatment for patients with rectal cancer. However, for those who cannot or will not undergo surgical treatment, radiation therapy alone may provide long-term survival and a high quality of life, according to a recent study in the International Journal of Radiation Oncology, Biology, and Physics (September 2002, Vol. 54:1, pp. 142-149).
The study, led by Dr. Jean-Pierre Gerard of the Centre Antoine Lacassagne in France, looked at 68 patients (median age 72) between 1986 and 1998. All of the patients had T2 or T3, N0-N1, M0 adenocarcinoma of the middle or lower rectum involving less than two-thirds of the circumference.
All patients underwent radiation therapy beginning with contact x-rays, followed by radiation therapy with a concomitant boost. This was followed by an iridium brachytherapy implant four to six weeks later in all but 7 of the patients.
At follow-up, a mean of 54 months later, the primary local tumor-control rate was 63%. After salvage surgery, pelvic control was achieved in 73% of patients. The overall survival at five years was 64.4%, and for patients under 80 years of age, it was 79%. Ten patients were alive and well at 10 or more years, the authors wrote.
There was no severe toxicity as a result of treatment, though most patients had proctitis that did not require treatment interruption, 24 patients had late rectal bleeding, and one required a blood transfusion. Good anorectal function was maintained in 92% of patients.
The T stage was a strong prognostic factor. Five-year overall survival was 84% for T2 patients, vs. 53% for T3 patients, the authors wrote.
Surgery remains, without doubt, the main treatment of rectal carcinoma, lead researcher Dr. Jean-Pierre Gerard told the Fairfax, VA-based American Society for Therapeutic Radiology and Oncology (www.astro.org). "Research aimed at improving the quality of life of patients with rectal cancer is ongoing, and this study contributes to that knowledge."
By AuntMinnie.com staff writers
August 28, 2002
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