Rectal cancer: Some patients may avoid radiotherapy

MONTREAL — Some patients with rectal cancer may not need radiation therapy, show results of a study unveiled at a conference of the American Society of Clinical Oncology.

These patients could be treated with chemotherapy alone before surgery, according to the PROSPECT study.

For some well-targeted patients, Dr. Carol Richard, chief of gastrointestinal surgery at CHUM, said, “80 to 90% of people will have a good response to chemotherapy, so maybe we can avoid radiotherapy.

“But it’s not for all patients,” said Dr. Richard. It is intended for cancers that are located in the middle part of the rectum and that do not have a very advanced disease factor.

She added that this study is part of the “on-demand treatment” trend of the past decade, which is seeing clinicians better define what constitutes the optimal treatment for a patient based on their particular characteristics.

Radiation therapy to the pelvis used to fight this cancer can cause serious side effects, especially in the bowel and bladder. It can also interfere with sexual function, and other side effects may not appear until years later.

The incidence of colorectal cancer is increasing among the younger population. The option to avoid radiotherapy is therefore interesting for those who want to protect their fertility or avoid premature menopause.

“Certainly these younger patients can have side effects that last much longer,” said Dr. Richard. So it’s a very relevant study.”

Besides these avoidable side effects, the study authors point out, radiotherapy is not available worldwide. So treatment with only chemotherapy can be beneficial in less equipped areas.

Dr. Richard said the new study does not prove that radiotherapy can and should be avoided at all costs for rectal cancer. But for some specific patients, we’re now seeing that it’s not necessary to get a perfect response.

She concluded, “We are currently targeting age-selective treatment based on tumor characteristics. Until then, we are also in the process of identifying the possibilities for full response and avoidance of surgery.”

The study results were published jointly by the New England Journal of Medicine and the Journal of Clinical Oncology.

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