Chemoradiation is effective in controlling anal and rectal cancers
but causes significant side effects and complications, according to
three independent teams of colorectal surgeons in Australia and the
The surgeons presented their findings at the annual meeting of the
American Society of Colon and Rectal Surgeons (ASCRS). They all
agreed that chemoradiation, either alone or following surgery, is
still the best way to prevent the recurrence of colon and rectal
cancers. However, each study team felt that further research is
needed to examine dosage amounts, mix of therapies, and delivery
methods of chemoradiation to reduce the incidence of side effects.
Study from Nebraska
In a study of patients with anal cancer treated with chemoradiation,
Harry Liberman, MD, Creighton University School of Medicine, Omaha,
Nebraska, reported that when patients received more than 3,000 cGy of
radiation, the frequency of complications increased, with no
significant benefit achieved in terms of tumor recurrence or survival.
Of 336 patients studied, roughly 11% received £
3,000 cGy of radiation and almost 89% received > 3,000 cGy. Among
patients receiving the larger doses of radiation, 75% had
complications. The incidence dropped in those who received smaller
doses, but was still significant at 59%.
Complications related to radiation included diarrhea (35.4%), skin
excoriation (35.1%), inflammation of the rectum (15.8%), incontinence
(12.2%), rectal narrowing (5.4%), impotence (1.8%), and loss of
In another study focusing on the use of chemoradiation in addition to
surgery, Dr. David Schache of Princess Alexandra Hospital, Brisbane,
Australia, reported that while chemoradiation is successful in
controlling tumors in rectal cancer, the side effects are significant.
Of 80 patients from the Queensland Radium Institute enrolled in the
study, 1 in 4 developed severe side effects during radiotherapy.
Chemotherapy was discontinued in 29% of patients because of severe
side effects, such as small bowel obstruction, diarrhea, nausea, and
vomiting. In 11 other patients, the dose of chemotherapy was reduced
due to complications. In a 3-year follow-up of the 80 patients, 30%
experienced late side effects.
Review of Randomized Trials
Reporting on a review of all existing randomized, controlled trials
of adjuvant chemotherapy and radiotherapy for resectable rectal
cancer, Joe Tjandra, MD, of the Royal Melbourne Hospital in
Australia, noted that pelvic floor function and quality of life were
impaired in 30% to 70% of patients treated with chemotherapy and
radiotherapy in addition to surgery.
The patient could develop very poor sphincter control. Almost
invariably, younger women will become postmenopausal, which can have
an impact on osteoporosis, said Dr. Tjandra. The
implications are enormous. We need to change the mix of therapies,
the amount, and the method of administration.