Younger patients don't attain survival benefit from current rectal cancer treatment recommendations

July 9, 2018, Wiley

A new study reveals that individuals younger than 50 years of age who are diagnosed with rectal cancer do not experience an overall survival benefit from currently recommended treatments. Specifically, the addition of chemotherapy and radiation to surgery does not prolong life for these patients. Published early online in Cancer, a peer-reviewed journal of the American Cancer Society, the findings suggest that early onset disease may differ from later onset disease in terms of biology and response to therapy.

The overall incidence of is decreasing in older than 50 years of age, likely due to improved screening adherence; however, there is a disproportionate increase in rectal incidence in patients under the age of 50 years. In addition, the mortality rate from rectal cancer among younger patients has increased in the past several decades.

Current national guidelines—which recommend a combination of chemotherapy, radiation, and surgery for stages II and III rectal cancer—are predominantly based on data from patients older than 50 years of age. To examine how younger patients fare, a team led by Atif Iqbal, MD, of the University of Florida College of Medicine, in Gainesville, examined 2004-2014 information from the National Cancer Database. A total of 52,519 patients were analyzed.

The team found that patients younger than 50 years old who have been diagnosed with rectal cancer represent a unique group. These younger patients do not see a survival benefit from receiving the currently recommended treatment for stages II and III rectal cancer.

"Our findings support the notion that rectal cancer in young patients may be biologically different from older patients, with differing response to treatment, as has been previously shown in colon cancer," said Dr. Iqbal. "These findings may help stimulate future research trial proposals focused on the younger patient population."

The study also reveals age-specific survival data for younger patients. "These data provide practicing physicians the ability to offer a prognosis personalized to the younger population, which can greatly improve discussions with younger patients."

In an accompanying editorial, Matthew Kalady, MD, of the Cleveland Clinic notes that the findings highlight the need to continually evaluate approaches to colorectal cancer prevention, screening, and treatment. "This manuscript should open the eyes of physicians treating rectal cancer patients and of those making treatment guideline recommendations and screening policies," he wrote. He noted that the study did not address other clinically important endpoints for rectal cancer patients such as local recurrence and disease-free survival. He added that studies are needed to evaluate how factors such as diet, physical activity and obesity, underlying genetics, and gut microbes may interact with rectal cancer biology.

Explore further: Many patients with rectal cancer may not need chemoradiotherapy

More information: "Rectal cancer patients under 50 years of age lack a survival benefit from NCCN guideline-directed treatment for stage II and III disease." Andrew Kolarich, Thomas J. George, Jr, Steven J. Hughes, Daniel Delitto, Carmen J. Allegra, William A. Hall, George J. Chang, Sanda A. Tan, Christiana M. Shaw, and Atif Iqbal. CANCER; Published Online: July 9, 2018, DOI: 10.1002/cncr.31527

"Rectal Cancer in Young Patients: Time to Take Notice." Matthew Kalady. CANCER; Published Online: July 9, 2018, DOI: 10.1002/cncr.31524

Related Stories

Many patients with rectal cancer may not need chemoradiotherapy

May 11, 2018
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 ...

Only half of advanced rectal cancer patients receiving standard therapy

April 13, 2016
While use of the standard therapy leading to the best outcome against locally advanced rectal cancer has increased over the past decade, only half of patients currently receive it, according to a new study. The authors of ...

New Zealand's colorectal cancer rates are on the rise in young adults

April 5, 2017
A recent analysis found a decrease in the overall incidence of colorectal cancer in New Zealand, but an increased incidence of rectal cancer in those under 50 years of age.

Age tied to spread of rectal cancer to lymph nodes

October 28, 2012
Rectal cancer is more likely to spread to the lymph nodes in younger patients, according to new findings that Fox Chase Cancer Center researchers will be presenting on October 29 at the American Society for Radiation Oncology's ...

Family history of colon cancer calls for earlier screening

March 21, 2017
(HealthDay)—If you've got a family history of colon or rectal cancers, you probably need to start screening for these conditions before you turn 50, a cancer expert says.

Not all 80-, 90-year-olds with rectal cancer are treated

August 4, 2017
(HealthDay)—About 15 percent of octogenarians and nonagenarians with stage II/III rectal adenocarcinoma do not receive treatment, according to a study published online July 31 in Cancer.

Recommended for you

Discovery of kidney cancer driver could lead to new treatment strategy

July 19, 2018
University of North Carolina Lineberger Comprehensive Cancer Center scientists have uncovered a potential therapeutic target for kidney cancers that have a common genetic change. Scientists have known this genetic change ...

Sunscreen reduces melanoma risk by 40 per cent in young people

July 19, 2018
A world-first study led by University of Sydney has found that Australians aged 18-40 years who were regular users of sunscreen in childhood reduced their risk of developing melanoma by 40 percent, compared to those who rarely ...

Analysis of prostate tumors reveals clues to cancer's aggressiveness

July 19, 2018
Using genetic sequencing, scientists have revealed the complete DNA makeup of more than 100 aggressive prostate tumors, pinpointing important genetic errors these deadly tumors have in common. The study lays the foundation ...

Complementary medicine for cancer can decrease survival

July 19, 2018
People who received complementary therapy for curable cancers were more likely to refuse at least one component of their conventional cancer treatment, and were more likely to die as a result, according to researchers from ...

Overcoming resistance to a standard chemotherapy drug

July 19, 2018
Despite being studied for decades, the chemotherapy drug cisplatin is revealing new aspects of how it works. Researchers at Winship Cancer Institute of Emory University have identified an enzyme responsible for making tumors ...

High fruit and vegetable consumption may reduce risk of breast cancer, especially aggressive tumors

July 19, 2018
Women who eat a high amount of fruits and vegetables each day may have a lower risk of breast cancer, especially of aggressive tumors, than those who eat fewer fruits and vegetables, according to a new study led by researchers ...

0 comments

Please sign in to add a comment. Registration is free, and takes less than a minute. Read more

Click here to reset your password.
Sign in to get notified via email when new comments are made.