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Positive results from a new treatment for locally advanced rectal cancer include sometimes avoiding surgery altogether. The chance of recurrence is also reduced. According to a detailed study conducted at Uppsala University and published in EClinicalMedicine, this approach is beneficial. “The tumor often disappears completely, which increases the chance of avoiding surgery and maintaining normal rectal and colon function. In addition, metastases are less common,” Bengt Glimelius, professor of oncology at Uppsala University and senior consultant at Uppsala University Hospital, said about the new method.
Around 2,000 people are diagnosed with rectal cancer in Sweden each year. One third of these people have a high risk of recurrence. When a person is diagnosed with rectal cancer, a part of the intestine is often removed, which may require a stoma or cause the person to have problems controlling the bowel. Patients are often first given radiotherapy or a combination of radiotherapy and concomitant chemotherapy for up to five weeks, followed by surgery and usually an additional round of chemotherapy for up to six months.
A study carried out by Uppsala University in the field of daily health care shows that the chances of eliminating the need for surgical removal of part of the intestine can be doubled if radiotherapy and chemotherapy are given first and then the patient undergoes surgery if necessary.
“If the tumor disappears completely during treatment, surgery is not needed. This means that the rectum remains safe and the need for a stoma and a new rectum is eliminated. When part of the rectum is surgically removed, the new rectum does not understand that it should avoid sending repeated signals to the brain that you need to use the toilet,” said Bengt Glimelius.
A large number of doctors, researchers and research nurses have contributed to this study. Data from a large number of patients were collected through the Swedish Colorectal Cancer Registry (SCRCR), which included 461 patients.
Locally advanced rectal cancer is traditionally treated with a combination of radiotherapy and chemotherapy, followed by surgery and further chemotherapy. Four years ago, a randomised study showed that an alternative approach of one week of radiotherapy followed by four months of chemotherapy resulted in more tumours disappearing completely and fewer distant metastases. However, afterward, local recurrences were slightly more frequent. Uppsala was the first region to choose to introduce this treatment, but with a shorter chemotherapy duration of three months. Several other regions followed later.
The new study confirms the results of a previous randomised study, but also that a significant increase in local recurrence was not observed here. “With the old treatment, the randomised study found no tumour in 14 percent of patients who underwent surgery. The new model doubled that figure to 28 percent. The new Swedish study had the same results, but showed no increase in the local recurrence rate after a follow-up of about five years. It is important to show that experimental treatments also work in everyday healthcare,” said Bengt Glimelius.
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