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Rectal Cancer Outcomes Best With Short-Course Radiation
Date:3/5/2009

his colleagues assessed how circumferential resection margin and the plane of surgery (the amount of tissue removed around the tumor) affected cancer recurrence risk in 1,156 people.

Of that group, 128 (11 percent) had involvement of the circumferential resection margin -- the presence of a tumor within 1 millimeter of the circumferential margin, which is associated with a high risk of local recurrence and poor survival. The plane of surgery was good (mesorectal) in 604 patients (52 percent), intermediate (intramesorectal) in 398 (34 percent) and poor (muscularis propria plane) in 154 (13 percent).

Three years after surgery, cancer had recurred locally in 6 percent of those with a negative circumferential margin and in 17 percent who had a positive circumferential margin. Local recurrence occurred in 4 percent of people in the mesorectal group, 7 percent in the intramesorectal group and 13 percent in the muscularis propria plane group.

For any plane of surgery achieved, short-course radiotherapy before surgery reduced local recurrence by about half, the study found.

"At present, only 50 percent of rectal cancer surgery is done in the mesorectal plane, suggesting that a further decrease in local recurrence rates might be obtained by improving the plane of surgery achieved," the researchers concluded. "[This could] be achieved through education and surgical tuition."

The findings of these studies show that "perioperative radiation can mitigate but not eliminate the adverse effects of imperfect surgery," Dr. Robert Madoff, of the University of Minnesota, wrote in an accompanying comment in the journal. "The best outcomes occurred when preoperative radiation was followed by optimum surgery. … The next challenge is to understand which patient needs what therapy to maximize his or her chances for a cure."

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