Benefits of pre-operative radiation and chemotherapy for rectal cancer

German surgeons randomly assigned patients with rectal cancer to receive chemoradiotherapy either before or after surgery. Although there was no significant difference in 5 year survival, patients who received pre-surgical therapy had less local recurrence of their cancers and fewer toxic side effects.

Over 800 patients were enrolled in the study -- 400 in each arm. At the end of five years, 76% of the pre-surgical group had survived, compared to 74% of those who received their radiation and chemotherapy after surgery.

However, there was a 6% recurrence of cancer at the site of the surgery in those receiving pre-surgical therapy as opposed to a 13% recurrence rate in post-surgical therapy patients. In addition, 40 % of the post-surgical group had serious toxic side effects, as compared to only 27% of those having pre-surgical treatment.

The German Rectal Cancer Study Group report their results in the October 21, 2003 edition of The New England Journal of Medicine.

Read the study abstract.

Cancer surgery at an NCI Comprehensive Cancer Center does not appear to improve overall survival compared to similar high-volume hospitals

Five-year survival rates after surgery to remove the colon done at an NCI-designated comprehensive cancer center appear to be no better than those of patients who had their surgery performed in a hospital with a high volume of such operations.

Nancy J. O. Birkmeyer, Ph.D. and a team at the University of Michigan Medical School assessed deaths after surgery and five-year survival for 63,860 older patients in the Medicare database(1994-1999) with six common cancers. They compared outcomes at the 51 NCI centers to 51 hospitals with the highest volume of surgery for each cancer.

For colon cancer, there were fewer deaths after surgery in the NCI comprehensive cancer centers. NCI centers had a 5.4% surgical mortality rate compared to 6.7% in the large-volume, non-NCI, hospitals.

However, there was no difference in long-term survival at five years.

The study authors concluded, "For many cancer procedures, patients undergoing surgery at NCI-designated cancer centers had lower surgical mortality rates than those treated at comparably high-volume hospitals, but similar long-term survival rates."

Her results will be published in the February issue of Cancer.

Read the abstract in an early on-line publication of Cancer.

Read an article about the study on Yahoo Reuters Health.

Combining PET Scan with CT scan and doing them at the same time improves doctors' ability to find spread of colorectal cancer

Simultaneous PET and CT scanning is more sensitive than CT scanning with contrast enhancement in finding metastases in patients with colorectal cancer. The new technique combines a full-ring PET scanner with a helical CT, enabling lesions detected by PET to be immediately imaged by CT.

Patients in the study received both an contrast-enhanced CT scan and the new combined PET/CT scan.

Using the new, more sensitive, approach doctors in Zurich were able to find:

• more metastases outside of the liver (64% vs 89%)
  
• new mets within the liver after a previous liver resection (50% vs 100%)
  
• recurrences at the site of the resection of the primary tumor (53% vs 93%)
  

The new approach was not better than contrast-enhanced CT in finding metastases within the liver.

The researchers concluded, "PET/CT and ceCT provide similar information regarding hepatic metastases of colorectal cancer, whereas PET/CT is superior to ceCT for the detection of recurrent intrahepatic tumors after hepatectomy, extrahepatic metastases, and local recurrence at the site of the initial colorectal surgery. We now routinely perform PET/CT on all patients being evaluated for liver resection for metastatic colorectal cancer."

Markus Selzner MD and his colleagues at the University of Zurich in Switzerland report their findings in the December 2004 issue of The Annals of Surgery. (Ann Surg 2004;240:1027-1036.)

Read an abstract of the study in The Annals of Surgery.

Read an article about the study on Medscape.