Positive outcomes from a novel treatment for locally advanced rectal cancer include the occasional full avoidance of surgery and a decrease in the chance of recurrence, according to a study conducted at Uppsala University and published in eClinicalMedicine.
“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, about the new method.
Rectal cancer affects around 2,000 people in Sweden each year, with a third having a high risk of recurrence. Traditionally, the treatment involves the removal of part of the bowel, which could lead to the need for a stoma or issues with bowel control. Patients typically undergo radiotherapy or a combination of radiotherapy and chemotherapy for five weeks, followed by surgery and usually an additional round of chemotherapy for up to six months.
The Uppsala University study highlights that it is possible to double the chance of eliminating the need for surgical bowel removal if all radiotherapy and chemotherapy are administered first, followed by surgery 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. 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,” explained Glimelius.
A large team of doctors, researchers, and research nurses contributed to the study, with patient data collected from the Swedish Colorectal Cancer Registry (SCRCR) involving 461 patients.
Locally advanced rectal cancer has traditionally been treated with a combination of radiotherapy and chemotherapy followed by surgery and additional chemotherapy. A previous randomised study showed that a different approach—one week of radiotherapy followed by over four months of chemotherapy—resulted in more complete tumour disappearance and fewer distant metastases, although it also noted slightly more local recurrences. Uppsala was the first to adopt this new treatment model with a shortened chemotherapy period of three months, a move later followed by other regions.
The new study reaffirms the positive results of the previous randomised study and demonstrates that the increased local recurrences previously observed were not present in this study.
“With the old treatment, the randomised study failed to find any tumour 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,” added Glimelius.
(With ANI Inputs)
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