Positive outcomes from a novel treatment for locally advanced rectal cancer include the occasional full avoidance of surgery and a decreased chance of recurrence. According to a thorough study done at Uppsala University and published in eClinicalMedicine, this approach is beneficial.
Effectiveness of the New Method
“The tumour disappears completely more often, thereby increasing the chance of avoiding surgery and retaining normal rectum and rectal function. Moreover, there are fewer metastases,” said Bengt Glimelius, Professor of Oncology at Uppsala University and Senior Consultant at Uppsala University Hospital.
Impact on Patients and Treatment
Rectal cancer affects around 2,000 people in Sweden every year. Of these, a third have a high risk of recurrence. When diagnosed, part of the bowel is often removed, potentially leading to the need for a stoma or issues with bowel control. Patients typically receive radiotherapy or a combination of radiotherapy and concurrent chemotherapy for five weeks, followed by surgery and usually an additional round of chemotherapy for up to six months.
Study Findings
A study conducted by Uppsala University in everyday healthcare shows that doubling the chance of eliminating the need to surgically remove part of the bowel is possible if all radiotherapy and chemotherapy are administered first, with surgery reserved for if necessary.
“If the tumour disappears completely during treatment, surgery is not required. This means that the rectum is preserved and the need for a stoma and a new rectum is eliminated,” said Glimelius. A large number of doctors, researchers, and research nurses contributed to the study. Patient data was collected from the Swedish Colorectal Cancer Registry (SCRCR), including 461 patients.
Comparison with Traditional Treatment
Locally advanced rectal cancer has traditionally been treated with a combination of radiotherapy and chemotherapy, followed by surgery and further chemotherapy. Four years ago, a randomized study showed that a new approach—one week of radiotherapy followed by just over four months of chemotherapy—resulted in more tumors disappearing completely and fewer distant metastases. Although slightly more local recurrences were noted later, Uppsala was the first region to adopt this treatment, albeit with a shortened chemotherapy period of three months. Several other regions followed suit.
Confirmation of Results
The new study confirms the results of the previous randomized study, with the noted increase in local recurrences not observed. “With the old treatment, the randomized study failed to find any tumor in 14 percent of patients who underwent surgery. The new model doubled that figure to 28 percent. The new Swedish study had the same results, but without an increase in local recurrence rate after almost five years of follow-up. It is important to show that experimental treatments also work in everyday healthcare,” Glimelius added.
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