A novel approach to treating rectal cancer, involving a longer course of chemotherapy and radiation therapy before surgical intervention, has shown promising results in a recent Swedish study. The findings suggest that this method can significantly increase the rate of complete tumor remission, potentially allowing more patients to avoid rectal removal surgery and maintain normal bowel function.
Enhanced Tumor Response
In the study, researchers administered an extended course of chemoradiation before surgery to 461 rectal cancer patients. The regimen included one week of radiotherapy followed by more than four months of chemotherapy. The results indicated a substantial improvement in tumor response compared to traditional methods, where a shorter course of chemo/radiation is given before surgery.
Bengt Glimelius, a professor of oncology at Uppsala University and lead author of the study, noted that the rate at which the tumor disappeared completely rose to 28% with the new approach, doubling the 14% observed in previous trials using the conventional method. This increase in complete remission translates to a greater chance of avoiding surgery and preserving the rectum.
Impact on Quality of Life
The primary advantage of this approach lies in its potential to improve patients' quality of life. Rectal cancer surgery often leads to bowel movement difficulties and may necessitate a colostomy, significantly impacting a patient's daily life. By increasing the likelihood of complete remission, the extended neoadjuvant chemoradiation strategy aims to preserve the rectum and its normal function.
"The rectum is preserved and the need for a stoma [colostomy] and a new rectum is eliminated," Glimelius explained. "When part of the rectum is surgically removed, the new rectum does not quite understand that it should be able to refrain from frequently sending a signal to the brain that you need to use the toilet."
No Increase in Recurrence
Importantly, the study found that the increased remission rate did not come at the cost of higher recurrence rates. According to Glimelius, the new approach helped cut the need for surgery "but without an increase in local [tumor] recurrence rate after almost five years of follow-up."
Current Treatment Landscape
Typically, rectal cancer treatment involves radiotherapy or a combination of radiotherapy and chemotherapy for five weeks, followed by surgery and additional chemotherapy for up to six months. This new approach challenges the conventional sequence, suggesting that a more intensive pre-operative treatment phase can lead to better outcomes for select patients.
Study Details
The study, published in eClinicalMedicine, involved 461 Swedish rectal cancer patients who received one week of radiotherapy followed by more than four months of chemotherapy prior to any surgery. The primary endpoint was the rate of complete tumor remission, with secondary endpoints including recurrence rates and quality of life measures.
