Researchers have conducted a large clinical trial which found that patients suffering from rectal cancer perform just as well without radiation therapy as they do with the treatment. The results could offer patients the opportunity to reject a cancer treatment which can have numerous side effects: over 10,000 US patients annually could be affected. Dr Eric Winer, President of the American Society of Clinical Oncology, explained that the research demonstrated the start of a new direction for cancer researchers. Dr Kimmie Ng, co-director of the colon and rectal cancer centre at the Dana-Farber Cancer Institute, noted that rectal cancer specially required the evaluation: “Now, especially, with patients skewing younger and younger, do they actually need radiation? Can we choose which patients can get away without this extremely toxic treatment that can lead to lifelong consequences, such as infertility and sexual dysfunction?”
The Study found that, on average, pelvic radiation – which impacts sexual function in both sexes and can push women into immediate menopause – did not improve outcomes for patients. The treatment can also result in bowel issues such as chronic diarrhea, pelvic fractures and the formation of additional cancers. The study was concentrated on patients whose tumors had spread to lymph nodes or tissues around the bowel, but not to other organs. This made up approximately half of the 800,000 newly diagnosed rectal cancer patients worldwide. There was no difference in key measures between the group that received radiation and the one that did not.
For the trial, 1,194 patients were randomly assigned to one of two groups. The first group received the standard treatment – radiation, surgery and then, after recovery from surgery, chemotherapy at the discretion of surgeons. The second group were given a new experimental treatment, which started with chemotherapy, then surgery and, if the chemotherapy did not shrink the tumor, radiation. These patients had radiation just 9% of the time.
The researchers excluded patients whose tumors seemed too dangerous for only chemotherapy and surgery. Informed patient consent was a vital component for the research to progress. Dr John Plastaras, a radiation oncologist at the Penn Medicine Abramson Cancer Center, commented: “Certainly the results are interesting – I’d like to see the patients followed for a longer time before concluding that outcomes with the two treatment options were equivalent.”