For patients with cancer in the lower part of the rectum that has not spread to the lymph nodes, chemotherapy administered before localized surgery is an effective method of preserving a patient’s surrounding organs, according to a new study by researchers at Fox Chase Cancer Center. The study, presented at the Eastern Cooperative Oncology Group and American College of Radiology Imaging Network (ECOG-ACRIN) Annual Meeting, offers a potential alternative to more invasive surgical procedures.
Organ Preservation in Rectal Cancer
Total mesorectal excision, the standard surgical approach involving removal of the rectal tumor along with a surrounding portion of the bowel, has proven highly effective for rectal cancer but carries significant risks of morbidity and mortality. Researchers at Fox Chase sought to determine whether tumor removal after chemotherapy would be an effective treatment to spare surrounding organs in patients with cancer in the lower part of the rectum that has not spread to the lymph nodes.
Study Design and Results
The study enrolled 19 patients diagnosed with node-negative rectal cancer in the lower rectum. These patients received neoadjuvant FOLFOX chemotherapy before undergoing local tumor excision. Following surgery, they were given chemoradiation and monitored to assess the effectiveness of the organ-preserving approach. According to Dr. Vanessa Wookey, Assistant Professor in the Department of Hematology/Oncology at Fox Chase Cancer Center and lead author on the study, 79% of patients achieved successful organ preservation, with no local recurrences reported at a median follow-up of more than 24 months.
Of the 19 patients, 16 underwent successful surgery and completed chemotherapy. One of these 16 patients experienced a metastatic recurrence, but no local recurrences were observed after two years.
Implications and Future Directions
"Neoadjuvant chemotherapy and local excision for node-negative, low rectal cancer followed by chemoradiation is a feasible organ-preserving approach and results in durable, long-term local control and preserved quality of life," said Wookey. The researchers believe that this approach warrants further investigation and could provide early data on the benefits of chemoradiation following surgery to target lymph nodes that are undetectable in radiological and clinical examinations. The study, titled “Phase II Study of Organ Preservation Using Neoadjuvant Chemotherapy and Local Excision in Node-Negative Low Rectal Cancer,” suggests a promising avenue for improving outcomes and quality of life for patients with low rectal cancer.
