The risk of recurrence of rectal cancer is less if a patient receives short-term radiation before surgery and then chemotherapy. This is evident from an international study, coordinated by the University Medical Center Groningen, the Leiden University Medical Center, the Karolinska Institutet and the Uppsala Universitet from Sweden.
The researchers expect that these results will lead to an adjustment of the standard treatment for advanced rectal cancer, the UMCG reported.
The current treatment of advanced rectal cancer consists of six weeks of radiotherapy combined with a low dose of chemotherapy (radiochemotherapy). The tumor is then surgically removed. With the new treatment, the patient receives radiation for one week followed by 18 weeks of chemotherapy. Then the operation takes place.
Address metastases at an early stage
“Irradiation with low dose chemotherapy ensures that the tumor becomes as small as possible and is therefore easier to remove during the operation and chemotherapy kills tumor cells that form metastases,” says radiation oncologist at the LUMC and Antoni van Leeuwenhoek Corrie Marijnen. “By giving chemotherapy before surgery, we tackle possible metastases at an early stage. In the meantime, the radiation can continue to work longer, so that the tumor can become even smaller before the operation. ”
Less tumor recurrence
In recent years, a total of 920 patients from seven countries with advanced rectal cancer have been treated with the standard or new treatment. Patients who received the updated treatment strategy developed less metastases. After 3 years, this was 20 percent of the patients, compared to 27 percent of the patients who received the standard treatment.
The new strategy made the tumor so small that in 28 percent of cases no tumor cells could be found in the rectum and surrounding lymph nodes. With the standard treatment this was only 14 percent.
Less hospital visits
The patients did have more side effects, because the chemotherapy is heavier. “But these side effects have not meant that patients could not be operated on. The number of complications after treatment was also the same in both groups, ”explains UMCG oncology surgeon Boudewijn van Etten.
An advantage is that patients have to come to the hospital much less often. In the standard treatment, patients come to the hospital 25 to 28 times and in the experimental treatment only 12 times.
The researchers expect that steps will now be taken to make this experimental strategy a standard treatment. Treatment of the patient before surgery is a leading therapy for this form of rectal cancer, with no surgery at all as a possible additional option in the future, ”said Geke Hospers, medical oncologist at the UMCG.
The results were published in the medical journal The Lancet Oncology on Tuesday.
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