Chemo may work better before cancer surgery

Administering chemotherapy and radiation before surgery for rectal cancer may not help patients live longer, but it produces fewer side effects than when given afterward, doctors report.

The finding, also published in Thursday’s edition of the New England Journal of Medicine, could translate into less suffering for those with rectal cancer, which affects about 42,000 people in the U.S. each year.

Traditionally, doctors have performed surgery first. But giving chemotherapy and radiation first may make the chemotherapy more tolerable and may shrink the tumor, making it easier to remove with less damage to the rest of the body, the researchers report.

Nearly 800 volunteers and doctors in 26 hospitals were involved in the test, which followed each patient for an average of four years. The team found that the five-year survival rate was about 75%, whether or not surgery was done first.

But the rate of short-term side effects such as diarrhea was 40% among patients who had surgery first, compared with 27% for those who had it after drug and radiation treatment. And having surgery after chemoradiation cut the risk of long-term side effects nearly in half.