Positive outcomes from a novel treatment for locally advanced rectal cancer include the occasional full avoidance of surgery. The chance of a recurrence is also decreased. According to a thorough study done at Uppsala University and published in eClinicalMedicine, the approach is beneficial. "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 Consultantat Uppsala University Hospital, about the new method.
Rectal cancer affects around 2,000 people in Sweden every year. Of
these, a third have a high risk of recurrence. When a person is diagnosed with
rectal cancer, part of the bowel is often removed, which could lead to the need
for a stoma or problems controlling one's bowels. Patients often first 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.
A study conducted by Uppsala University in everyday healthcare
shows that it is possible to double the chance of eliminating the need to
surgically remove part of the bowel if all radiotherapy and chemotherapy are
given first and then the patient undergoes 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," said Bengt Glimelius.
A large number of doctors, researchers and research nurses have contributed
to the study. Patient data was collected for a large number of patients via the
Swedish Colorectal Cancer Registry (SCRCR), with 461 patients included.
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 randomised study showed that an alternative
approach of one week of radiotherapy followed by just over four months of
chemotherapy resulted in more tumours disappearing completely and fewer having
distant metastases. Later on, however, slightly more local recurrences were
observed. Uppsala was the first region to choose to introduce this treatment,
but with a shortened chemotherapy period of three months. Several other regions
later followed suit.
The new study confirms the results of the previous randomised
study, but also that the noted increase in local recurrences was not observed
here. "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 per cent. 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," said Bengt Glimelius.
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