For decades we've asked patients to accept the loss of their rectum – and often a permanent stoma – as the price of curing their cancer.
Chemoradiotherapy patients were also less likely to need radical surgery than those who received radiotherapy alone.
Hans de Wilt described similar experiences among patients treated in the Netherlands: "Patients for whom the organ-preserving treatment was successful were often very happy.
Dutch clinical guidelines have already been revised: patients with rectal cancer can now opt for organ-preserving treatment, with chemoradiotherapy as the preferred approach and short-course radiotherapy as an alternative for those who cannot tolerate chemotherapy.
Patients interested in organ-preserving treatment for rectal cancer are advised to discuss the option with their treating specialist.
For decades we've asked patients to accept the loss of their rectum – and often a permanent stoma – as the price of curing their cancer. These results suggest that for many people, this price no longer has to be paid Simon Bach
At 12 months, chemoradiotherapy proved the more effective organ-preserving strategy: 79% of patients who received it avoided radical surgery entirely or needed only the local procedure, keeping their rectum intact. In the short-course radiotherapy group, this was achieved in 61% of patients. Chemoradiotherapy patients were also less likely to need radical surgery than those who received radiotherapy alone.
The trial was coordinated by the Cancer Research UK Clinical Trials Unit (CRCTU) at the University of Birmingham, with academics from UCL and the University of Leeds, and led in the Netherlands by Radboudumc surgical oncologist Hans de Wilt together with radiotherapist Corrie Marijnen of Leiden University Medical Center (LUMC) and the Netherlands Cancer Institute.
"For decades we've asked patients to accept the loss of their rectum – and often a permanent stoma – as the price of curing their cancer," said Professor Simon Bach, co-chief investigator of STAR-TREC, Honorary Chair at the University of Birmingham and Professor of Colorectal Surgery at UCL. "These results suggest that for many people, this price no longer has to be paid."
Hans de Wilt described similar experiences among patients treated in the Netherlands: "Patients for whom the organ-preserving treatment was successful were often very happy. They did not need to undergo major surgery and did not require a stoma." He noted that even those who ultimately still required surgery generally viewed their choice positively, as they had first been able to try to preserve their rectum.
David Sebag-Montefiore, co-chief investigator and Professor of Clinical Oncology at the University of Leeds, highlighted the radiotherapy technique itself: "It is gratifying that patients experienced a relatively low level of severe short-term side effects as a result of the smaller, more targeted radiotherapy approach that we specifically developed for STAR-TREC."
Dutch clinical guidelines have already been revised: patients with rectal cancer can now opt for organ-preserving treatment, with chemoradiotherapy as the preferred approach and short-course radiotherapy as an alternative for those who cannot tolerate chemotherapy.
Researchers are now following patients for a further three years to determine whether cancer recurrence rates and overall survival are comparable to radical surgery in the longer term. Ongoing work also aims to better predict which patients are most likely to benefit from organ preservation, and to explore whether outcomes can be improved further. "Our goal is personalised treatment," said De Wilt. "This allows us to provide each patient with the care that best suits them." Bach added that the next step is "to confirm these results hold over the longer term, and then to make sure the approach is available to every patient who could benefit."
Patients interested in organ-preserving treatment for rectal cancer are advised to discuss the option with their treating specialist.
Source: Radboudumc / University of Birmingham
