Radiotherapy for cancer: Impact of additional pre-irradiation and / or postoperatively in cancer patients nil, says large multiyear study published in the Lancet

March 2002: Source: The Lancet

The Lancet (a leading medical journal) is an article posted on a study of 8507 patients across 22 trials that evaluated the impact brought by additional pre-irradiation and / or subsequent to cancer patients in addition to surgery compared with surgery alone. The results are objectively very disappointing, although the group of researchers has concluded an attempt to interpret a positive result. But The Lancet also published a letter from Dr. Ralph Moss (Writer Yahoo Questioning chemotherapy etc. and see his site www.cancerdecisions.com ) who is negative about the outcomes and high questioned radiotherapy for cancer. (see (translated) letter from Ralph Moss in this article) The difference in mortality between the two groups was indeed 45% to 50% (p = 0.0003), but that was 8% compared to 4% (p = 0.0001) deceased people for other reasons caused by radiation, which the profits of the first digit is eliminated. And then the side effects are not included in these figures. The conclusion is therefore justified that irradiation before or after surgery adds little to the chances of recovery from cancer and / or chances of a recurrence. I dare not do as a doctor and absolute seemed to notice that supplementing with healthy diet and supplementation may improve the chances may increase. See, eg effects of certain vitamins in radiation, chemotherapy and hormone therapy on page research and nutrition, there is a whole scheme based on scientific studies.

Adjuvant radiotherapy for rectal cancer: a systematic overview of 8507 Patients from 22 randomized trials

Colorectal Cancer Collaborative Group *

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Correspondence to: CCCG Secretariat, University of Birmingham Clinical Trials Unit, Park Grange, 1 Somerset Road, Edgbaston, Birmingham B15 2RR, UK (e-mail: bctu@bham.ac.uk )

Summary

Background At least 28 randomized, controlled trials have compared outcomes of surgery for rectal cancer combined with Preoperative or post-operative radiotherapy with surgery alone or Those. We have done a collaborative meta-analysis or synthesis results to give a more balanced view of the total evidence and to increasefontsize statistical precision.

Methods We cents rally checked and analysed individual patient data from 22 randomized Comparison between Preoperative (6350 patients in 14 trials) or post-operative (2157 in eight trials) radiotherapy and no radiotherapy for rectal cancer.

Findings Overall survival was only marginally better in Patients who Were Allocated to radiotherapy Than In Those Allocated to surgery alone (62% vs. 63% died; p40 ° 06). Curative resection rates or apparently Were not improved by Preoperative radiotherapy (85% radiotherapy vs 86% control). Local Recurrence or yearly risk was 46% (SE 6) lower in Those Who had Preoperative radiotherapy Than In Those who had surgery alone (p = 0.00001), and 37% (10) Those who had lower in post-operative treatment Than Those Who had surgery alone (p = 0.002). Fewer Patients who had Preoperative radiotherapy died from rectal cancer did Than Those who had surgery alone (45% vs. 50%, respectively, p = 0.0003), but early (1 year after treatment) deaths from Other Causes Increased (8% vs 4% died, p <0.0001).

Interpretation Preoperative radiotherapy (30 Gy at Biologically effective doses) Reduces Risk of Local Recurrence and death from rectal cancer. If Safety Can Be Improved effectiveness without compromise, then overall survival Would be moderately improved by use of Preoperative radiotherapy, Especially for young, high-risk patients. Post Operative radiotherapy Also Reduces Local Recurrence, but short Preoperative Radiation Schedules Seem to be at least as effective as longer schedules.

Below the beef Dr. Ralph Moss nav above article also published in The Lancet. Here my free Dutch translation:

Sir, The Colorectal Cancer Collaborative Group I shows clearly that preoperative or postoperative radiation have a noticeable and measurable effect on the ultimate survival of patients with this disease (cancer). Patients who received postoperative radiotherapy had a 9% lower risk of dying from bowel cancer than control patients who received surgery alone. But the survival advantage is wiped out by the increased mortality from other causes in the radiation group. General terms wasthe risk of dying from causes other than the colon cancer 15% higher in those who received radiotherapy than in the control group, a significant difference.

The Collaborative Group states that there is no clear benefit of radiotherapy for ultimate survival. Yet B. Minsky believes in his commentary of oct.2001 20 (ed: in the Lancet) that the study results support additional radiotherapy for bowel cancer. This conclusion is drawn because postoperative radiotherapy the risk of recurrence within five years reduces by 7%. The Collaborative Group also believes that since an uncontrolled (without treatment) local relapse a devastating effect on quality of life for patients, improved local control by irradiation sufficient advantage to justify this treatment. YES, uncontrolled local recurrences are devastating and terrible. But also many deaths caused by excessive radiation, such as by cardiovascular diseases, infections and other unknown causes. The researchers mention that Minsky and the side effects of radiation on the gastrointestinal quality of life of patients can destroy. Patients who received radiation treatments for colon cancer heben more chronic stomach problems (dysfunctions) than patients receiving only surgery. OA diarrhea, bleeding, tenesmus (know any Dutch word for this) and pain with bowel movements are frequent during radiation therapy.

These symptoms stop when the radiation is partially put stop. However, six months to one year or sometimes even later, delayed post-irradiation may develop symptoms. In a medical textbook, these symptoms are described as follows: "There can be two to four, sometimes eight stools moments and pressure can be irresistible. Often we see blood there. Tenesmus is regular and cramps are often associated with the feces. Irradiation "proctitis (here know no word for Dutch) is regularly accompanied by pain and bleeding, the latter can be serious and persistent, sometimes even leading to necessary blood transfusions .... severe or complete obstruction (the intestines) can develop.

Some estimates of radiation therapy should be taken into consideration and not just the statistical effect on recurrence, but some patients actually experienced as a result of treatment. What patients need is a complete picture of the benefits and costs (ed: having or figuratively), it is impossible without well-considered and studied choices for treatment. Colon rectal cancer but how many I wonder will be told that additional radiation therapy has not been proven to prolong life but in fact serious short-and long-term side effects? How many patients will be told that additional irradiation in fact, lead to their inevitable death?

Ralph W. Moss

Below the original letter in English published in the Lancet, in March 2002.


Lancet 2001, 358: 1291-304

Sir - The Colorectal Cancer Collaborative Group1 Clearly Show That Neither Preoperative normal post operative radiation therapy HAS an appreciable effect on overall survival in patient with this disease.

Patients who Received post-operative radiation therapy did have a 9% lower risk of death from rectal cancer Than controls. But this survival advantage was all but Wiped out by the more frequent deaths from Other Causes in the radiation therapy group. Overall, the risk of death from Causes Other Than rectal cancer was 15% higher in Those Who Received Radiation Therapy Than in Those Who Did Not, a significant difference.


The Collaborative Group state That there was no clear benefit or radiotherapy for overall survival. Yet, Minsky B, In His commentary Oct 20, 2 Believes That the study results support the use of adjuvant radiation therapy for rectal cancer. That arises becauses Conclusion Preoperative radiation therapy did Decrease the chance of a Recurrence at 5 years by 7%. The Collaborative Group Also Believe That since uncontrolled local Recurrence CAN Have A Devastating Impact on patients' quality of life, improved local control with radiotherapy Might Be sufficient is a benefit to justify this treatment's use.

Yes, uncontrolled local recurrences are Devastating. But so too are excess deaths caused by radiation therapy, Such As through cardiovascular disease, infections, and other, unknown, Causes. The researchers do not mention Minsky and thats the side-effects to the bowel or radiation therapyDevastate can-patients' quality of life. Patients receiving radiation therapy for rectal cancer have more chronic bowel dysfunction Than Those who do undergo resection Surgical alone.3 diarrhea, bleeding, tenesmus, and pain are frequently on Defecation consistently therapy.

Ralph W. Moss

These syndromes has only comm Subside When treatment stops. However, 6 months to 1 year or more later, delayed post radiation syndromes has can-developement. In one textbook thesis Symptoms are described: "There May Be two to four or even eight or more bowel movements a day, and the urgency May Be compelling. Blood Also Often seen. Tenesmus is frequent, and cramping pain is Often associated with Defecation . Radiation proctitis is frequently associated with pain and bleeding, the Latter May Be persistent and severe, Occasionally Requiring transfusions... Severe or complete obstruction May developement. "4

Any assessment or radiation therapy must take account not just write the statistical effect of treatment on recurrences, but what patiënten Actually experience as a result of the treatment. What Patients and Their families need is the complete picture, as well as costs or benefits, without Which it is impossible for themself to make educated treatment Decisions. But how many rectal cancer patients, I wonder, are Told That HAS adjuvant radiation therapy not proven to extend life but leg May in fact cause serious short-term and long-term adverse effects? How many are Told That May adjuvant radiation in fact lead to Their untimely deaths?
Ralph WMoss