Upfront Therapy May Decrease Need for Rectal Cancer Surgery

Surgery for rectal cancer may not be needed if patients receive chemotherapy and radiotherapy upfront, researchers found.

Upfront chemotherapy and radiotherapy may help reduce the need for surgery in patients with locally advanced rectal surgery, according to recent research.

Not only can this treatment method decrease the chance of surgery, but it was also shown to increase the rate of patients who experienced a pathologic complete response (meaning that cancer can no longer be detected), while reducing the rate of recurrences compared to patients who received chemotherapy and radiotherapy, followed by surgical removal of the cancer and then more chemotherapy.

The findings of this study — which was conducted by a team of Swedish researchers — were laid out in a recent issue of eClinicalMedicine, which is part of The Lancet.

“The tumor disappears completely more often, thereby increasing the chance of avoiding surgery and retaining normal rectum and rectal function. Moreover, there are fewer metastases,” Bengt Glimelius, professor of Oncology at Uppsala University and Senior Consultantat Uppsala University Hospital, said in a press release about the findings.

The current standard-of-care treatment for locally advanced rectal cancer includes surgery to remove the cancer and nearby lymph nodes and then chemotherapy, according to the American Cancer Society. For cancers that may not be able to be completely removed via surgery neoadjuvant (presurgical) chemotherapy or immunotherapy may be given so that the tumors can shrink and eventually be easier to surgically resect. Additionally, advanced cancers that were surgically removed but attached to a nearby organ or still have remaining bits of tumor after resection may be treated with radiation, the organization explained.

Patients in the trial all had high-risk locally advanced rectal cancer. They received short-course radiotherapy followed by four cycles of the chemotherapy regimen, CAPOX (capecitabine and oxaliplatin) or six cycles of FOLFOX-6 (leucovorin calcium, fluorouracil and oxaliplatin). Then, they underwent surgery and more chemotherapy, if needed, or had a watch-and-wait approach.

“Hence, two chemotherapy cycles less do not compromise the results maintaining a high [complete response] rate. This [total neoadjuvant treatment] schedule resulted in favorable outcomes in a nationwide, real-life situation,” the authors wrote.

READ MORE: Longer Intervals Between Rectal Cancer Therapies May Improve Responses

These findings confirmed the benefits of upfront treatment that were previously observed in the RAPIDO trial. However, the researchers noted that in RAPIDO, those who did not undergo surgery and more chemotherapy tended to eventually have a higher rate of local (near the site of the original tumor) recurrence. That was not the case with this more recent study.

“With the old treatment, the randomized study failed to find any tumor in 14 percent of patients who underwent surgery. The new model doubled that figure to 28 percent. The new Swedish study had the same results, but without an increase in local recurrence rate after almost five years of follow-up. It is important to show that experimental treatments also work in everyday health care,” Glimelius said in the release.

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