Share on PinterestA recent study reveals that radiation may not be necessary for specific types of rectal cancer. PER Images/Stocksy
- A groundbreaking study shows that some individuals with rectal cancer might be able to forego radiation.
- The experiment involved over 1,100 participants with locally advanced rectal cancer, indicating that it had not metastasized to other areas of the body.
- After a period of five years, researchers discovered that patients who underwent chemotherapy alone prior to surgery achieved similar results to those who received both chemotherapy and radiation before surgery.
Certain individuals with locally advanced rectal cancer could bypass radiation therapy without any impact on their survival, according to a large-scale clinical trial.
Pelvic radiation therapy is a conventional treatment for this type of cancer, however, it can result in severe side effects.
The rectum, which is situated in the pelvis adjacent to the anus, is the last section of the large intestine.
Exposing this area to radiation can lead to alterations in bowel habits, bladder irritation, pelvic bone weakening, and a risk of infertility, particularly in women.
The study results were disclosed in early June at the annual meeting of the American Society of Clinical Oncology and a paper published in the New England Journal of Medicine.
“The main finding of this study is that radiation therapy is not required for some rectal cancer patients,” remarked Dr. Afsaneh Barzi, a medical oncologist at City of Hope in Duarte, Calif. who was not involved in the study, in an interview with Healthline.
The new approach is considered to be “essentially the preferable treatment [for these patients], given that radiation has long-lasting side effects,” she added.
Dr. Jun Gong, a hematology oncologist at Cedars Sinai in Los Angeles who was not involved in the study, stated that the results will directly impact the treatment of this form of rectal cancer.
“This is what we refer to as a ‘practice-changing study,’ where clinicians can take these findings and begin to apply them to their patients in the clinic as early as tomorrow,” he told Healthline.
Gong emphasized that the goal of the study was not to completely eliminate radiation therapy as a treatment for rectal cancer, but rather to identify a subset of patients who could benefit from skipping radiation without compromising survival outcomes.
In fact, he noted, “this subset of patients could be clinically significant, as we frequently encounter rectal tumors with intermediate risk in the clinic.”
While the new treatment offers patients and doctors an additional option, there will still be cases where radiation is necessary before surgery.
For instance, some patients in the study who were assigned to the chemotherapy-only group eventually received both chemotherapy and radiation therapy, similar to the standard treatment group.
This included individuals who were unable to complete at least five sessions of chemotherapy due to drug-related side effects.
Also included were those whose primary tumor did not decrease by at least 20% following chemotherapy with the six drugs, which occurred only 9 percent of the time.
This aspect of the study protocol ensured that those in the experimental group received the most effective treatment for their specific situation.
“This was sort of a built-in safety plan,” explained Gong, “because the investigators wanted to ensure that they were not compromising efficacy.”
Considering the number of individuals potentially eligible for the new treatment, Barzi stated that the impact of the study on rectal cancer treatment would be “significant.”
According to the American Cancer Society, approximately 46,000 people are diagnosed with rectal cancer each year.
“We believe that about 20,000 of these individuals, who have stage 2 or 3 cancer, could benefit from this approach, which can spare them from having to undergo radiation in addition to chemotherapy and surgery,” noted study author Dr. Deb Schrag, a gastrointestinal oncologist at Memorial Sloan Kettering Cancer Center in New York City, in a news release.
The results are particularly relevant for individuals diagnosed with rectal cancer at a young age, as preserving fertility becomes a crucial concern.
“Approximately 30% of rectal cancer patients are under the age of 50,” said Barzi. “These are younger individuals, so the findings of this study, including the impact on quality of life, may actually be important for their decision-making process.”
There are also differences in the intensity of the treatments that could influence individuals’ decisions on which treatment to choose.
Chemotherapy and radiation prior to surgery require 28 daily visits over five and a half weeks, while chemotherapy alone, as performed in the new study, only requires six visits over 12 weeks.
For individuals who opt for chemotherapy alone before surgery, Barzi highlighted that “there is some flexibility in terms of scheduling, which is valuable,” particularly for younger patients who are in school or have work commitments.
All in all, “[the new treatment method] is a welcomed addition,” she stated, “and provides another option for patients, as well as another opportunity for shared decision-making between patients and their physicians.”
In addition to the patient, Gong mentioned that treatment decisions should involve a multidisciplinary healthcare team consisting of medical oncologists, radiation oncologists, surgical oncologists, and pathologists.
“The entire team will collectively determine which patients are suitable candidates for the [new] regimen or other treatment pathways,” he explained.