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Midgley and Kerr state that the use of systemic chemotherapy in
either Dukes' B or C rectal cancer is unproven. (1) In fact, the
combination of post-operative chemotherapy and radiotherapy has been shown
to be more effective than post-operative radiation alone in two randomised
trials. (2,3) This is why post-operative chemotherapy with radiation is
the current standard for B2-C rectal cancers in Australasia and North
America. As noted in the article pre-operative therapy has advantages,
thus the use of combination therapy prior to surgery warrants further
investigation. (4)
(2) Krook JE, Moertel CG, Gunderson LL, Wieand HS, Collins RT, Beart
RW, Kubista TP, Poon MA, Meyers WC, Mailliard JA, et al Effective surgical
adjuvant therapy for high-risk rectal carcinoma. N Engl J Med.1991;324:709
-15.
(3) Gastrointestinal Tumor Study Group. Prolongation of the disease-
free interval in surgically treated rectal carcinoma. N Engl J Med
1985;312:1465-72.
(4) Elsaleh H, Joseph D, Levitt M, Dewar J, Van Hazel G, Einhorn S,
Cameron F, Osborne M, Latham M, Robbins P. Pre-operative chemo-
radiotherapy in locally advanced rectal cancer: is this the way of future
management? Australas Radiol 1999;43:215-9.
Competing interests:
No competing interests
06 December 2000
Sean Bydder
Registrar
Department of Radiation Oncology, Sir Charles Gairdner Hospital
Adjuvant systemic therapy in rectal cancer
Midgley and Kerr state that the use of systemic chemotherapy in
either Dukes' B or C rectal cancer is unproven. (1) In fact, the
combination of post-operative chemotherapy and radiotherapy has been shown
to be more effective than post-operative radiation alone in two randomised
trials. (2,3) This is why post-operative chemotherapy with radiation is
the current standard for B2-C rectal cancers in Australasia and North
America. As noted in the article pre-operative therapy has advantages,
thus the use of combination therapy prior to surgery warrants further
investigation. (4)
Sean Bydder, Registrar.
s_bydder@hotmail.com
Department of Radiation Oncology, Sir Charles Gairdner Hospital, Nedlands
Western Australia, Australia WA 6008
(1) Midgley RSJ, Kerr DJ. ABC of colorectal cancer. Adjuvant therapy.
BMJ 2000;321:1208-1211.
(2) Krook JE, Moertel CG, Gunderson LL, Wieand HS, Collins RT, Beart
RW, Kubista TP, Poon MA, Meyers WC, Mailliard JA, et al Effective surgical
adjuvant therapy for high-risk rectal carcinoma. N Engl J Med.1991;324:709
-15.
(3) Gastrointestinal Tumor Study Group. Prolongation of the disease-
free interval in surgically treated rectal carcinoma. N Engl J Med
1985;312:1465-72.
(4) Elsaleh H, Joseph D, Levitt M, Dewar J, Van Hazel G, Einhorn S,
Cameron F, Osborne M, Latham M, Robbins P. Pre-operative chemo-
radiotherapy in locally advanced rectal cancer: is this the way of future
management? Australas Radiol 1999;43:215-9.
Competing interests: No competing interests