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10 July 2017

Not all patients with rectal cancer require surgery. This is the conclusion of researchers from Radboud university medical center after they analyzed data from the Netherlands Cancer Registry. Currently, almost all patients with early-stage rectal cancer undergo surgery to remove the tumor, but this appears not to be necessary in all cases. The Radboudumc Center for Oncology has launched an international study into two rectum-conserving treatments. On July 5th, the first Dutch patient was enrolled in this study.

In recent years, more and more rectal cancer patients who were treated with radiation and chemotherapy no longer underwent surgery. Surgery can lead to a stoma or problems with defecation, urination and sexual functioning. However, rectum-conserving treatment is still used for only a few patients.
Netherlands Cancer Registry
To determine whether more patients could benefit from rectum-conserving treatment, Radboud university medical center researcher Anouk Rombouts studied data from the Netherlands Cancer Registry (Dutch acronym: NKR). The NKR is a database with reliable, objective data on all cancer patients in the Netherlands. Together with a team of researchers, they determined how many patients with rectal cancer still had tumor tissue following radiotherapy and possible chemotherapy. It turned out that no tumor tissue could be detected in 10% to 20% of the patients. 
Unnecessary surgery
Because more patients could apparently undergo rectum-conserving cancer treatment, the Radboudumc Center for Oncology has initiated a study to compare the current surgical treatment with two rectum-conserving treatments. Hans de Wilt, professor of Oncological Surgery at Radboud university medical center, explains: “Until now our standard procedure was to perform surgery on rectal cancer patients after radiotherapy, but Anouk Rombouts' study indicates that this is not necessary in all cases. Rectum-conserving treatment therefore appears to be an option for more patients with rectal cancer.”
The international study STARTREC will compare the standard surgical treatment with two rectum-conserving treatments. One of these treatments is a short (one-week) radiotherapy treatment, the other is a longer (five week) period of radiotherapy with additional chemotherapy. Patients with rectal cancer will soon be able to enroll in the study at 12 centers * in the Netherlands. The study will also be conducted in Denmark and England. Hans de Wilt is coordinating the study: “STARTREC aims to answer the question of whether these rectum-conserving treatments are as effective as standard surgery. In addition, we want to determine which of these treatments provides the best short-term and long-term results.”
In addition to the STARTREC study, two other national organ-conserving studies are ongoing: the TESAR study and the Wait-and-See registry. Radboud university medical center is the first academic hospital where patients have the option of enrolling in these three studies.

*Participating centers: Radboudumc, Isala, LUMC, Amphia, Catharina Ziekenhuis, AvL, VUmc, IJsselland Ziekenhuis, MC Leeuwarden, Elisabeth-TweeSteden Ziekenhuis, Diakonessenhuis en Laurentius Ziekenhuis.

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