Doctors More Than Halve Local Relapse Of Rectal Cancer
Rectal cancer patients who receive a combination of improved surgical techniques and short-course radiotherapy before surgery have a strong chance of remaining cancer-free, according to two articles published in this week’s edition of The Lancet.
The study shows that high quality surgery and a five day course of radiotherapy cuts recurrence rates to just 1%, compared with about 13% with standard surgery alone.
Both reports are based on an assessment of data collected during the Medical Research Council funded CR07 trial and the CO16 trial funded by the National Cancer Institute of Canada.
One report assessed how the amount of tissue removed around the tumour by surgeons affected the rates of rectal cancer recurrence.
The findings, based on 1156 patients from the UK, Canada, South Africa and New Zealand, with operable rectal cancer, shows that surgery rated as ‘good’ that removes the whole of the rectum – known as the ‘mesorectal plane’ - is the most successful.
The results are so convincing that this high quality surgery technique is already being used by surgeons.
“At present, only 50% of rectal cancer surgery is done in the mesorectal plane, suggesting that a further decrease in local recurrence rates might be obtained by improving the plane of surgery… [This can] be achieved through education and surgical tuition,” said Professor Phil Quirke, Yorkshire Cancer Research Centenary Professor of Pathology, a pathologist from the University of Leeds, and lead author of the paper.
The accompanying report, led by Dr David Sebag-Montefiore from St James’s University Hospital in Leeds, compared the effectiveness of short-course pre-operative radiotherapy, with a five week course of radiotherapy and chemotherapy reserved for those patients considered at high risk of the cancer returning. The reason for the latter option was that radiation given in the pelvic area can lead to sexual and bowel problems.
1350 patients were randomly assigned either five daily treatments of radiotherapy followed by surgery, or surgery followed by 25 treatments of radiotherapy and chemotherapy for those at high risk of a local recurrence.
Findings show that after three years 4 % of patients in the radiotherapy group had a local recurrence, compared with 11% of patients in the surgery and selective treatment group.
Richard Stephens from the Medical Research Council Clinical Trials Unit said: “These studies add further weight to the argument that the quality of surgery achieved improves outcomes in rectal cancer patients, and that short-course pre-operative radiotherapy improves them even more, even when good surgery has been performed.”
“The results of the trial mean that patients will now be able to make an informed decision about the benefits and side effects of pre-operative radiotherapy. What the trial clearly shows is that both treatments combined have the best outcome in treating rectal cancer.”