Some Rectal Cancer Patients May Be Able to Avoid Radiation Treatment, Study Finds A new clinical trial found that a chemotherapy-only approach to treatment yielded equally positive results as the traditional chemoradiation combination.
Radiation treatment for rectal cancer patients is often painful, with possible complications like infertility risk and hindered sexual function
- A new clinical trial found that a chemotherapy-only approach to treatment yielded equally positive results as the traditional chemoradiation combination.
- Radiation treatment for rectal cancer patients is often painful, with possible complications like infertility risk and hindered sexual function.
- Experts note that this treatment is specific to low-risk patients with mid-to-high rectal cancer; high-risk patients or those with low rectal cancer will still require radiation.
Rectal cancer patients may have a new, less painful treatment option.
Announced at the American Society of Clinical Oncology (ASCO)’s annual meeting and spearheaded by researchers at Memorial Sloan Kettering Cancer Center (MSK), a clinical trial found a possible new path forward in treatment for rectal cancer patients that would bypass the painful, often disruptive regimen of radiation therapy before surgery.
This data was gathered from more than 1,100 trial participants with locally advanced rectal cancer. Participants were either given FOLFOX—a drug regimen that includes 5-fluorouracil (5FU), oxaliplatin, and leucovorin—or the traditional pre-surgery chemoradiation combination.
Study authors found that individuals who’d undergone FOLFOX experienced results that were just as favorable as the more traditional, painful chemotherapy and radiation therapy.
The clinical trial provides a window of understanding into possible treatments for people with this form of cancer, potentially improving one's overall quality of life.
“I think this is a big game changer,” Martin Weiser, MD, the surgical co-primary investigator of the study, told Health.
By avoiding radiation and relying solely on chemotherapy, individuals with locally advanced rectal cancer could avoid hindered sexual function and fertility—just two examples of the many disruptions radiation treatment can often bring.
“NCCN guidelines generally recommend radiation for this cohort which can now be eliminated in most patients without detriment in the oncologic outcome. This will reduce toxicity and improve sexual, bladder, and bowel function,” Dr. Weiser said.
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An Alternative to Radiation
Radiation therapy has long been crucial to cancer treatment but often results in many difficult, complicated side effects.
People who have rectal cancer face a host of radiation complications tied to a part of the body that is particularly sensitive and crucial to some of our most important bodily functions. It might result in infertility, early menopause, damage to reproductive organs, weakened pelvic bones, irritation to the bladder, and even shifts in bowel habits, among other complications.
It’s understandable why finding an alternate form of treatment would be a huge improvement for rectal cancer patients.
“The study data are important as they identify a select group of low-risk rectal cancer patients that can be successfully treated without the use of radiation therapy,” Hyun Kim, MD, associate professor and chief of the Gastrointestinal Service at Washington University School of Medicine, explained to Health.
He added that while the data is exciting, it only applies to a specific group of low-risk patients.
Dr. Kim, who is unaffiliated with the trial and is also the chief of MR Clinical Services and co-director of the Young Onset CRC Center at Washington University School of Medicine and the Siteman Cancer Center, said it's also important to note that any cancer treatment—whether radiation, chemotherapy, or surgery—poses the risks of side effects.
“The study showed that there were double the rates of severe on-treatment toxicity in the chemotherapy arm compared to the chemoradiation arm,” he said. “The rate of neuropathy was more than 4 times higher in the chemotherapy arm.”
This means that patients who can’t risk a loss of dexterity—musicians, seamstresses, surgeons—may want to opt for traditional chemoradiation therapy.
When asked what stood out the most about the trial’s findings, Dr. Weiser, a colorectal surgeon at Memorial Sloan Kettering Cancer Center, said he and the rest of the team were “very happy” with the results.
“Bowel, bladder, and sexual function were improved in the chemotherapy—the experimental—arm of the study,” he said.
Benefiting Younger Generations of Rectal Cancer Patients
In recent years, medical professionals have seen an increase in colorectal cancer among younger generations.
In fact, research projects that colorectal incidences and deaths in people 20 to 49 years old will rise over the next two decades, becoming the second leading cancer for younger people in 2040.
With that in mind, the results of this trial might be particularly appealing to younger people who are undergoing rectal cancer treatment.
“These data are exciting in that younger patients that are interested in fertility preservation can now be reassured that their rectal cancer can be safely treated without radiation if they meet these trial criteria,” Dr. Kim said.
“Young women will also be able to avoid premature ovarian failure, which is frequently a consequence of pelvic radiation,” he added.
Dr. Weiser echoed those points. He said that since younger people being treated for cancer “are expected to live longer and would generally endure the toxicity of radiation” for a much longer period of time, this new approach would be a positive move forward.
Not All Patients Can Avoid Radiation Therapy
Even with newer treatment options, there are some people who will still require a more traditional approach to treating rectal cancer.
Dr. Weiser pointed to situations when “very bulky tumors” encroach upon the sphincter muscles of the anus or penetrate the rectum’s outer layers. In these instances, the traditional method of pelvic chemoradiation may be preferred.
“Despite the exciting conclusion that chemotherapy and surgery are not inferior to chemoradiation and surgery, it is important to remember that this is not universally applicable,” Dr. Kim said.
He noted that the study was specific to low-risk patients, with mid-to-high rectal cancers. Patients who are high-risk, or have lower cancers may still require radiation.
Dr. Kim also pointed out a movement of treating patients nonoperatively with radiation and chemotherapy, omitting surgery altogether.
“It is possible that patients who are treated with radiation and chemotherapy–without surgery—may report even better quality of life than patients treated with chemotherapy and surgery—without radiation,” he explained. “Thankfully, there are many ongoing clinical trials evaluating these exciting new treatment paradigms.”
Looking to the Future
According to Dr. Kim, the trial’s results will enable providers and patients to choose treatment options that best meet the needs of someone who has low-risk rectal cancer.
More evidence, by way of prospective clinical trials, will be needed to understand if this type of treatment “is safe and efficacious in patients with more locally advanced rectal cancers,” he said.
Dr. Weiser said the size of the trial makes the results compelling, and he expects this approach to be “widely adopted as the oncologic results are similar and function is improved in the chemotherapy-only patient.”
“Eliminating the long-term effects of pelvic radiation will be attractive to patients and physicians,” Dr. Weiser said. “In addition, in rural areas where access to linear accelerators, or radiation machines, can be limiting and require traveling many miles each day, a chemotherapy-only approach would facilitate treatment.”
This story originally appeared on: Health News - Author:Brian Mastroianni
