Preoperative Concurrent Chemotherapy and Radiation Improves Local Control and Sphincter Preservation

10/20/2003

From: Beth Bukata, 703-227-0141, Katherine Egan Bennett, 703-227-0156, both of the American Society for Therapeutic Radiology and Oncology

WASHINGTON, Oct. 20 -- When comparing postoperative and preoperative concurrent chemotherapy and radiation (CRT), preoperative CRT significantly improves local control and in low-lying tumors, sphincter preservation, according to a German rectal cancer study presented on October 20, 2003, at the American Society for Therapeutic Radiology and Oncology's 45th Annual Meeting in Salt Lake City.

The standard treatment for patients with resectable rectal cancer is surgery. In recent years, encouraging results of preoperative CRT have been reported. This phase III randomized clinical trial compared the efficacy of nonadjuvant CRT to standard postoperative CRT.

Patients with clinically staged T3 and T4 rectal cancers were randomly assigned to preoperative or postoperative concurrent chemotherapy and radiation. Of the 823 patients randomized in 26 participating institutions, 392 were evaluable in postoperative CRT, showing a disease free rate of 55 percent and an overall survival rate of 73 percent, and 405 were evaluable in preoperative CRT, showing a disease free rate of 59 percent and an overall survival rate of 78 percent. Significantly fewer patients experienced chronic anastomotic stenosis following preoperative CRT compared to postoperative CRT.

Postoperative morbidity was not increased after preoperative CRT and there was a significant tumor downstaging following the preoperative CRT.

"In the subgroup of 188 patients with low-lying tumors who were declared by the surgeon prior to randomization to require an abdominoperineal resection, 19 percent underwent a sphincter preservation procedure in the postoperative concurrent chemotherapy and radiotherapy arm. This significantly increased to 39 percent following preoperative concurrent chemotherapy and radiotherapy," said Rolf Sauer, M.D., a physician at Strahlenklinik in Erlangen, Germany, and lead author of the study. "This large increase shows us that preoperative concurrent chemotherapy and radiotherapy are extremely helpful in improving local control and sphincter preservation." If you would like a copy of the abstract entitled, "Adjuvant vs. Neoadjuvant Combined Modality Treatment for Locally Advanced Rectal Cancer: First Results of the German Rectal Cancer Study," or you would like to speak to the lead author of the study, Rolf Sauer, M.D., please call Beth Bukata after October 18 in the ASTRO Press Room at the Salt Palace Convention Center at 801-534-4743 or e-mail her at bethb@astro.org.

The American Society for Therapeutic Radiology and Oncology is the largest radiation oncology society in the world, with more than 7,000 members who specialize in treating patients with radiation therapies. As a leading organization in radiation oncology, biology and physics, the Society's mission is to advance 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.