It's unclear whether all patients with advanced rectal cancer need chemoradiotherapy, or whether some can forego the treatment and therefore be spared its side effects. A new BJS (British Journal of Surgery) study found that patients who are not at high risk of local recurrence can safely undergo surgery without receiving chemoradiotherapy. Investigators estimate that this strategy could reduce the number of patients who receive chemoradiotherapy by roughly half, with only a minimal risk of undertreatment.
In the observational trial, 545 patients with cancer of the rectum were stratified into low-and high-risk groups. Chemoradiotherapy was administered to patients at high risk and was avoided in 42% of patients. The 3- and 5-year local recurrence rates of cancer were similarly low in patients who had surgery alone (a procedure called total mesorectal excision) versus patients who received chemoradiotherapy followed by surgery.
"The results are an important step to an individualized therapy of rectal cancer," said co-author Prof. Theodor Junginger, of the University Medical Centre Mainz, in Germany. "The concept avoids adverse effects of chemoradiotherapy, shortens duration of treatment, and saves costs."
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R. Ruppert et al, Oncological outcome after MRI-based selection for neoadjuvant chemoradiotherapy in the OCUM Rectal Cancer Trial, British Journal of Surgery (2018). DOI: 10.1002/bjs.10879