Thousands of bowel cancer patients could be spared a life-altering surgery following a landmark trial for earlier-stage rectal cancer.
Scientists have discovered that four in five patients who received chemoradiotherapy, and a more localised surgery when needed, were able to avoid a permanent stoma and keep their rectum.
Around 4,100 patients are diagnosed with early-stage rectal cancer each year in the UK, and currently receive a radical procedure that removes the whole rectum and causes bowel dysfunction, sexual and urinary problems, and a permanent colostomy bag.
Researchers from University College London, the University of Birmingham and the University of Leeds hope the findings, which were published in The Lancet Oncology, will mean the treatment soon becomes standard.
Michelle Mitchell, the chief executive of Cancer Research UK, which funded the trial alongside Stand Up To Cancer, said: “This breakthrough could be life-changing for thousands of people.”
She added: “Thanks to bowel screening, more rectal cancers are being spotted at an earlier stage, where people are more likely to survive the disease, but that hasn’t made treatment any easier – many patients still have to cope with extremely difficult and often life-altering side effects.
“Remarkably, that could finally be about to change with this new treatment option, which has the potential to transform the lives of people affected by this cancer and their families.”
To conduct the study, researchers took more than 500 patients from five countries, including England, and split them into three groups.
One group was given five weeks of chemoradiotherapy, one was given five days of radiotherapy, and the other group was given the current standard treatment of radical surgery.
Those who received chemoradiotherapy or radiotherapy also underwent a rectum-preserving surgery if the treatment alone was not shrinking their tumour enough.
After a year, patients who received five weeks of chemoradiotherapy were less likely to require radical surgery than those who had five days of radiotherapy.
Researchers are now following patients for the next three years to see if the cancer is more likely to come back without radical surgery, and whether there is a difference in survival.
Professor Peter Johnson, NHS England national clinical director for cancer, said: “The NHS is always seeking to improve the treatment of cancer, and many patients already benefit from having radiotherapy before an operation for their rectal cancer.
“The results of this research are important in pointing the way for us to avoid radical surgery for more people in the future.”
Simon Bach, co-chief investigator of the Star-Trec trial and Professor of Colorectal Surgery at University College London, said: “For decades we’ve asked patients to accept the loss of their rectum – and often a permanent stoma – as the price of curing their cancer. These results suggest that for many people, that price no longer has to be paid.
“Four in five patients treated with chemoradiotherapy kept their rectum. The next step is to confirm these results hold over the longer term, and then to make sure the approach is available to every patient who could benefit.”
