Chemotherapy prevents local recurrence but doesn't prolong survival in patients with rectal cancer

Preoperative radiotherapy is a standard treatment option for patients with stage T3 or T4 rectal cancers. The role of chemotherapy is less clear. A clinical trial found that additional chemotherapy based on fluorouracil had no impact on patients' survival, but it did help to prevent local recurrences whether it was given before or after surgery.

Four groups of patients (total 1011) had preoperative radiotherapy plus either preoperative chemotherapy, postoperative chemotherapy, both, or neither. About 65% of them survived for five years regardless of their assigned treatment. But patients who had no chemotherapy at all were more likely to have a local recurrence (17%) than the other three groups (8.7%, 9.6%, and 7.6%, P = 0.002).

The timing of the chemotherapy didn't seem to matter, except that patients who had their treatment before surgery were more likely complete it. Less than half the patients who were meant to have postoperative chemotherapy managed to complete the course specified by the protocol of the trial. Over a quarter failed to start, mostly because they had postoperative complications, disease progression, or simply said no.

The authors conclude that preoperative chemotherapy with fluorouracil is probably worth considering for some patients.

Children with otitis media do well with optional antibiotics

American doctors often prescribe antibiotics for children with acute otitis media, even though there is good evidence from Europe that a “wait and see” policy can work just as well. They now have their own culturally specific evidence from a large trial set in an urban emergency department in New Haven, Connecticut. Children whose parents were given a delayed prescription to fill in if their child wasn't better (or got worse) over the next two days had similar short and medium term outcomes as children who were given antibiotics immediately. Immediate antibiotics made no difference to the children's …