Short-Course Radiotherapy Shows Positive Results in Anal Cancer Treatment

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A Polish phase 3 study has found that a short-course (five-day) radiation followed by consolidation chemotherapy prior to surgery has similar results to that of a five-week chemotherapy.

“There is a great need for improvement of pre-operative strategies for patients with locally advanced rectal cancer,” study co-author Lucjan Wyrwicz, MD, PhD, head of Medical Oncology Unit in Department of Gastrointestinal Cancer at the Maria Sklodowska-Curie Memorial Cancer Center in Warsaw, Poland, said in a press release.

“The new regimen has similar efficacy but causes fewer side effects and is more convenient for patients,” Dr. Wyrwicz said. “It is also less costly compared to standard chemoradiation, so it may be especially valuable in limited-resource settings.”

Both the United States and some European countries have chemoradiation therapy as the primary standard of care among cancer patients. It is often used in anal cancer prior to surgery to reduce the size of tumors and lessen the rates of cancer recurrence.

The researchers enrolled 515 cancer patients into the study, who were assigned to either a chemoradiation group or an experimental group. Patients either had stage III or stage IV rectal cancer.

Patients in the chemoradiation group were given fluourouracil, leucovorin and oxaliplatin chemotherapy with the radiation. The researchers noted, however, that adding oxaliplatin to fluourouracil and radiation is not standard practice in the U.S. as it has high levels of toxicity.

Patients in the experimental group, on the other hand, received the same agents in the so-called FOLFOX4 regimen after the short course radiation. Patients from both groups all underwent surgery at about 12 weeks after starting radiotherapy and six weeks after the neoadjuvant treatment.

After radiation therapy, a similar proportion of patients from both groups were able to undergo a radical surgery. The rates of acute toxicity were found lower in the experimental group compared to the chemoradiation group, at 74% versus 83%.

At three years, the rate of disease-free survival was almost the same in both groups at 53% and 52%. However, the initial report indicates a higher survival rate for the experimental group compared to the chemoradiation group, at 73% versus 63.5%.

 "If this survival benefit is confirmed with longer follow-up, it might ultimately result in change to the clinical practice in patients with locally advanced rectal cancer similarly to the studied group of patients" added Dr. Wyrwicz.

The study authors note that the neoadjuvant treatment may be particularly helpful for patients who have advanced rectal cancer.

The study will be presented at the 2016 Gastrointestinal Cancers Symposium. Read the full abstract here.