Study finds that some patients with rectal cancer may be able to omit radiation exposure

More than 1,100 people with locally advanced rectal cancer participated in the trial, which means the rectal cancer has not spread to other parts of the body.

Some people were excluded from the trial because their tumors were too advanced in the rectum or too low in the rectum, making them high-risk patients.

People were randomly assigned to receive one or both of the standard treatments for this type of cancer. chemotherapy and radiation Before surgery — or chemotherapy alone before surgery.

The chemotherapy used during treatment was a combination of three separate agents administered over six sessions. People in the standard care group received one chemotherapy drug.

Both groups had the option of receiving additional chemotherapy after surgery at the physician’s discretion.

Five years later, researchers found that people who received chemotherapy alone before surgery were as effective as those who received both chemotherapy and radiation before surgery.

Results showed that key outcomes such as disease-free survival, overall survival, and cancer recurrence rate were nearly identical for the two treatments.

Being able to avoid radiation without compromising survival could mean a better quality of life for people, including reducing the risk of fertility and sexual dysfunction.

As part of the study, researchers also collected data on people’s side effects and quality of life. These results were announced separately on June 4th. Journal of Clinical Oncology.

Researchers found that people who did not receive radiation therapy had lower rates of diarrhea and bowel dysfunction. However, some side effects, such as anxiety, were lower in the radiotherapy group. Anorexia and constipation.

Twelve months after surgery, the group not receiving radiotherapy had a lower incidence of fatigue and neurological symptoms, and had better sexual function.

Gong said the goal of the new study was not to eliminate radiation therapy entirely as a treatment for rectal cancer, but to identify a subset of patients who would benefit from omitting radiation therapy while maintaining survival outcomes. It was pointed out that

In fact, “this could be a clinically meaningful subset of patients because we see intermediate-risk rectal tumors frequently in our clinic,” he said. .

Although new treatments offer new options for patients and doctors, radiation therapy may still be required before surgery in some cases.

For example, some patients assigned to the chemotherapy-only group in this study ended up receiving the same chemotherapy and radiation therapy as the standard care group.

This included people who were unable to complete at least five chemotherapy sessions due to drug side effects or other reasons.

They also included people whose primary tumors did not decrease by at least 20% after six-drug chemotherapy, but only 9%.

This aspect of the study protocol ensured that people in the group received the most effective treatment for each particular situation.

“It was like a built-in safety plan,” Gong said. “The researchers wanted to make sure they didn’t sacrifice efficacy.”

Bulge said the study’s impact on rectal cancer treatment would be “substantial,” given the number of people who could potentially be targeted by the new treatment.

Approximately 46,000 people are diagnosed with rectal cancer each year, according to the US. American Cancer Society.

“We believe that about 20,000 of these people (with stage 2 or 3 cancer) can benefit from this approach, which does not require radiation therapy in addition to chemotherapy or surgery.” study author Dr. Johnson said. Deb Shrugsaid a gastrointestinal oncologist at Memorial Sloan Kettering Cancer Center in New York City. news release.

This result is particularly important for people diagnosed with rectal cancer at a young age, where preserving fertility is an important concern.

“About 30% of rectal cancer patients are under the age of 50,” said Barzi. “Because they are young people, the results of this study, including the quality of life component, may be of real importance to their decision making.”

There is also a difference. intensity of treatment It can influence people’s decisions about which treatment to choose.

Preoperative chemotherapy and radiation therapy requires 28 daily visits over five and a half weeks. Chemotherapy alone, as done in the new study, requires only six visits over 12 weeks.

For patients who choose chemotherapy alone before surgery, “there is some freedom in terms of scheduling, which is worth it,” Bulge said. “Particularly young patients, those in the formative years of life, may be at school or at work.”

whole, “[the new treatment method] “This is a welcome addition,” she said, “providing new options for patients and new opportunities for shared decision-making between patients and physicians.”

Gong said treatment decisions need to involve the patient as well as a multidisciplinary team of medical oncologists, radiation oncologists, surgical oncologists, and pathologists.

“The whole team will decide which patients are candidates for treatment.” [new] We have to choose regimens and other routes of treatment,” he said.