A novel approach for treating locally advanced rectal cancer demonstrates promising outcomes, allowing the possibility of completely forgoing surgery. Additionally, it significantly lowers the chances of the cancer returning. The effectiveness of this strategy has been validated through an extensive study conducted at Uppsala University and published in eClinicalMedicine.
Bengt Glimelius, a Professor of Oncology at Uppsala University and Senior Consultant at Uppsala University Hospital, commented on the advancement: “The tumour often disappears entirely, enhancing the likelihood of evading surgery and preserving the normal rectum along with its functioning. Moreover, there are fewer occurrences of metastases.”
Each year, approximately 2,000 individuals in Sweden are diagnosed with rectal cancer, with around one-third facing a high risk of recurrence. Typically, when diagnosed, a portion of the bowel is removed, which could necessitate the use of a stoma or lead to bowel control issues. Patients generally undergo five weeks of radiotherapy or a combined regimen of radiotherapy with chemotherapy, followed by surgery and often another six months of chemotherapy.
A study by Uppsala University within standard healthcare settings indicates that the chances of eliminating the need for bowel removal can be doubled by administering all radiotherapy and chemotherapy before considering surgery.
Glimelius adds, “If the tumour completely disappears during treatment, surgery becomes unnecessary. This preservation of the rectum eliminates the need for a stoma and a new rectum. When a part of the rectum is surgically removed, the new rectum often struggles to properly signal the brain about when to use the toilet.”
The study involved a significant collaboration among doctors, researchers, and research nurses, with data from numerous patients collected through the Swedish Colorectal Cancer Registry (SCRCR), encompassing 461 patients.
Traditionally, locally advanced rectal cancer has been managed with a combination of radiotherapy and chemotherapy followed by surgery and subsequent chemotherapy. Four years prior, a randomized study revealed that a different approach—consisting of one week of radiotherapy followed by just over four months of chemotherapy—led to a higher complete disappearance rate of tumours and fewer distant metastases. However, this approach initially resulted in a slightly increased rate of local recurrences. Uppsala was the first region to adopt this method, but with a reduced chemotherapy duration of three months, which other regions later imitated.
The new study reinforces the findings from the previous randomized trial and also shows that the increase in local recurrences was not observed in this analysis.
“In the previous randomized study, surgery revealed no tumours in 14 percent of patients. The new method has doubled that rate to 28 percent. The recent Swedish study exhibited similar results, yet without an increase in local recurrence after nearly five years of follow-up. It is vital to demonstrate that innovative treatments are effective in real-world healthcare settings,” concludes Bengt Glimelius.
