Rectal cancer patients could be spared the effects of radiation

Large 'de-escalation' trial suggests tens of thousands of people each year may rely on chemotherapy and surgery alone to treat their disease .< /p>

Rectal cancer researchers have achieved a daunting feat by demonstrating in a large clinical trial that patients do just as well without radiation therapy as with it.

The results, revealed Sunday at the American Society of Clinical Oncology annual meeting and in an article in the New England Journal of Medicine, could give more than 10,000 patients each year in the United States the option of foregoing a cancer treatment that can have serious side effects.

The study is part of a new direction for cancer researchers, said Dr. Eric Winer, president of the oncology organization, but was not involved in the trial.

"Now as cancer treatments have improved, researchers are starting to ask different questions,” he said. "Instead of asking how to intensify cancer therapy, they ask if there are elements of effective treatments that can be eliminated to provide patients with a better quality of life."

That's why researchers re-examined the standard treatment for rectal cancer, which affects 47,500 people a year in the United States (although the class of disease in the study affects about 25,000 Americans a year ).

For decades it was common practice to use pelvic radiation therapy. But radiation puts women into immediate menopause and damages sexual function in both men and women. It can also injure the gut, causing problems like chronic diarrhea. Patients risk pelvic fractures and radiation therapy can cause other cancers.

Yet radiation therapy, according to the study, did not improve outcomes. After a median follow-up of five years, there was no difference in key measures – time to survival without signs of cancer recurrence and overall survival – between the group that received the treatment and the group that did not. had not done. And, after 18 months, there was no difference between the two groups in terms of quality of life.

For colon and rectal cancer specialists, the results can be life-changing for their patients, said Dr. Kimmie Ng, co-director of the Colon and Rectal Cancer Center at the Dana-Farber Cancer Institute, who was not one of the authors of the study.

“Now, especially, with patients getting younger and younger, do they really need radiation therapy? " she asked. "Can we choose which patients can get away with this extremely toxic treatment that can lead to lifelong consequences, such as infertility and sexual dysfunction?"

Dr. John Plastaras, a radiation oncologist at Penn Medicine Abramson Cancer Center, said the results “are certainly interesting,” but added that he would like to see patients followed longer before concluding that results with both treatment options were equivalent. .

The trial focused on patients whose tumors had spread to lymph nodes or tissues around the intestine, but not to other organs. This subset of patients, whose cancer is considered locally advanced, constitutes approximately half of the 800,000 newly diagnosed rectal cancer patients worldwide.

In the study, 1,194 patients were randomly assigned to one of two groups. One group received the standard treatment, a long and arduous ordeal that began with radiation therapy, followed by surgery and then, once the patients recovered from surgery, chemotherapy at their doctor's discretion.

The other group received the experimental treatment, which consisted first of chemotherapy, followed by surgery. At their doctor's discretion, another round of chemotherapy may be given. These patients only received radiation therapy if the initial chemotherapy failed to shrink their tumors, which happened only 9% of the time.

...

Rectal cancer patients could be spared the effects of radiation

Large 'de-escalation' trial suggests tens of thousands of people each year may rely on chemotherapy and surgery alone to treat their disease .< /p>

Rectal cancer researchers have achieved a daunting feat by demonstrating in a large clinical trial that patients do just as well without radiation therapy as with it.

The results, revealed Sunday at the American Society of Clinical Oncology annual meeting and in an article in the New England Journal of Medicine, could give more than 10,000 patients each year in the United States the option of foregoing a cancer treatment that can have serious side effects.

The study is part of a new direction for cancer researchers, said Dr. Eric Winer, president of the oncology organization, but was not involved in the trial.

"Now as cancer treatments have improved, researchers are starting to ask different questions,” he said. "Instead of asking how to intensify cancer therapy, they ask if there are elements of effective treatments that can be eliminated to provide patients with a better quality of life."

That's why researchers re-examined the standard treatment for rectal cancer, which affects 47,500 people a year in the United States (although the class of disease in the study affects about 25,000 Americans a year ).

For decades it was common practice to use pelvic radiation therapy. But radiation puts women into immediate menopause and damages sexual function in both men and women. It can also injure the gut, causing problems like chronic diarrhea. Patients risk pelvic fractures and radiation therapy can cause other cancers.

Yet radiation therapy, according to the study, did not improve outcomes. After a median follow-up of five years, there was no difference in key measures – time to survival without signs of cancer recurrence and overall survival – between the group that received the treatment and the group that did not. had not done. And, after 18 months, there was no difference between the two groups in terms of quality of life.

For colon and rectal cancer specialists, the results can be life-changing for their patients, said Dr. Kimmie Ng, co-director of the Colon and Rectal Cancer Center at the Dana-Farber Cancer Institute, who was not one of the authors of the study.

“Now, especially, with patients getting younger and younger, do they really need radiation therapy? " she asked. "Can we choose which patients can get away with this extremely toxic treatment that can lead to lifelong consequences, such as infertility and sexual dysfunction?"

Dr. John Plastaras, a radiation oncologist at Penn Medicine Abramson Cancer Center, said the results “are certainly interesting,” but added that he would like to see patients followed longer before concluding that results with both treatment options were equivalent. .

The trial focused on patients whose tumors had spread to lymph nodes or tissues around the intestine, but not to other organs. This subset of patients, whose cancer is considered locally advanced, constitutes approximately half of the 800,000 newly diagnosed rectal cancer patients worldwide.

In the study, 1,194 patients were randomly assigned to one of two groups. One group received the standard treatment, a long and arduous ordeal that began with radiation therapy, followed by surgery and then, once the patients recovered from surgery, chemotherapy at their doctor's discretion.

The other group received the experimental treatment, which consisted first of chemotherapy, followed by surgery. At their doctor's discretion, another round of chemotherapy may be given. These patients only received radiation therapy if the initial chemotherapy failed to shrink their tumors, which happened only 9% of the time.

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