Until recently, surgery involving the complete removal of the rectum was the standard treatment for rectal cancer. However, new international research co-led by Radboudumc, shows that many patients now have an alternative. One year after treatment with combined radiotherapy and chemotherapy, the rectum was preserved in 79% of patients. As a result, the Dutch clinical guidelines have been updated.
Each year, approximately 3,500 people in the Netherlands are diagnosed with rectal cancer. In these patients, the tumor is in the final part of the large intestine. Until recently, this diagnosis almost always meant major surgery in which the rectum was completely removed. Such surgery often has a profound impact. Many patients require a temporary or permanent stoma and experience long-term complaints, such as frequent urgency to defecate and problems with urination or sexual function.
Researchers therefore conducted an international study to investigate whether organ-preserving treatment with radiotherapy, with or without chemotherapy, could be a safe and effective alternative to surgery. The study was led in the Netherlands by Radboudumc surgical oncologist Hans de Wilt and radiotherapist Corrie Marijnen of LUMC and the Netherlands Cancer Institute.
Preserving the rectum
A total of 503 patients participated in the study. They were able to choose between surgery and an organ-preserving treatment, with the vast majority opting for the latter. Within this group, half received a short course of radiotherapy, while the other half was treated with a combination of radiotherapy and chemotherapy.
The one-year results are encouraging. In 79% of patients who received both radiotherapy and chemotherapy, the treatment was effective: surgery was no longer necessary or could be limited to a minimally invasive transanal procedure, while the rectum was preserved. In the group that received only a short course of radiotherapy, this outcome was achieved in 61% of patients.
‘Patients for whom the organ-preserving treatment was successful were often very happy,’ says De Wilt. ‘They did not need to undergo major surgery and did not require a stoma.’ Even patients who ultimately still need surgery generally look back positively on their choice. ‘They felt it was important to first try everything possible to preserve their rectum,’ De Wilt adds.
Tailored treatment
The Dutch clinical guidelines have now been updated. Patients with rectal cancer can now opt for organ-preserving treatment. Within this approach, radiotherapy combined with chemotherapy is preferred. For patients who are not eligible for chemotherapy, a short course of radiotherapy may be a suitable alternative.
Further research is needed to determine whether the organ-preserving approach can also prevent surgery in the long term. In addition, researchers aim to improve predictions of which patients are most likely to benefit from this approach and to explore whether even more effective treatments are possible. ‘Our goal is personalized treatment,’ says De Wilt. ‘This allows us to provide each patient with the care that best suits them.’
For more information about organ-preserving treatment for rectal cancer, patients are advised to discuss this option with their treating specialist at their next appointment.
About the publication
This research was published in The Lancet Oncology: Chemoradiotherapy versus short-course radiotherapy for response-adapted organ preservation in early and intermediate-stage rectal cancer (STAR-TREC): 12-month results of an international, randomised, phase II/III trial. Simon Bach, David Sebag-Montefiore, Victoria Homer, […], Simon Gates, Corrie Marijnen, Hans de Wilt. DOI: 10.1016/S1470-2045(26)00228-7.
The study was funded by the Dutch Cancer Society (KWF) and Stichting Bergh in het Zadel voor de Kankerbestrijding.
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