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Pre-Surgical Radiation May Help Patients with Rectal Cancer and Improve Treatment

Pre-Surgical Radiation for Rectal Cancer

Surgery is the most common treatment for rectal cancer, but does come with complications risks. Researchers in Sweden are researching how to improve your treatment options.


Colorectal cancer is the third most common cancer diagnosed in both men and women in the United States. (The rectum specifically is the lower 6-8 inches of the large intestine). The American Cancer Society estimates that there will be almost 40,000 new cases of rectal cancer diagnosed in 2017.

Surgery is usually the main treatment for rectal cancer, although radiation and chemotherapy will often be given before or after surgery. The type of surgery used depends on the stage (extent) of the cancer, where it is, and the goal of the surgery.

Possible risks of surgery include reactions to anesthesia, bleeding, blood clots in the legs, damage to nearby organs, and infections at the surgery site.

Researchers with the Karolinska Intitutet in Sweden have found that a short-course of preoperative radiation therapy reduces the risk of rectal cancer surgery without compromising its effectiveness. It may also help with reducing the risk of local recurrence by 50%, says principal investigator Anna Martling.

Radiation therapy does come with its own set of side effects, so finding the right “formula” for treatment is essential. The researchers tested three treatment plans:

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• Standard therapy, i.e. short-course (5x5 Gy) radiotherapy with direct surgery within a week.
• Delayed surgery with short-course (5x5 Gy) radiotherapy followed by surgery after 4-8 weeks.
• Delayed surgery with long-course (25x2 Gy) radiotherapy followed by surgery after 4-8 weeks.

The researchers found no significant difference in “short course” or “long course” treatments – except that the longer course obviously lengthened total treatment time for the patient. However, those with “delayed surgery” developed fewer complications with equally good cancer-related outcomes.

"The results of the study will give rise to improved therapeutic strategies, fewer complications with a sustained low incidence of local recurrence, and better survival rates for rectal cancer patients," says Professor Martling. "The results can now be immediately put to clinical use to the considerable benefit of the patients."

Journal Reference:
Johan Erlandsson, Anna Martling et al. Optimal fractionation of preoperative radiotherapy and timing to surgery for rectal cancer (Stockholm III): a multicentre, randomised, non-blinded, phase 3, non-inferiority trial. The Lancet Oncology, 2017; DOI: 10.1016/S1470-2045(17)30086-4

Additional Resources:
National Cancer Institute
American Cancer Society

Photo Credit:
By Patricounet - Own work, CC BY-SA 3.0, via Wikimedia Commons