Can Radiotherapy Offer Surgery-Free Rectal Cancer Treatment?

New research in the field of rectal cancer suggests that the condition may be effectively treated using a combination of radiotherapy and chemotherapy, without the need for surgery. Such a development may have life-changing implications for patients.

Partly funded by Cancer Research UK and carried out by experts at University College London and the universities of Birmingham and Leeds, this study into early rectal cancer treatment offers hope for a surgery-free alternative.

The STAR-TREC trial

This has emerged from the findings of the STAR-TREC trial, which involved more than 500 patients from five countries recruited for the trial, all of whom had been given an early diagnosis of rectal cancer.

Some of the patients were given an intensive five-day course of radiotherapy, while others underwent five weeks of chemotherapy alongside radiotherapy.

This was sufficiently early that if the treatment was ineffective, the usual approach of using surgery would be the next step.

Key findings

Long-course chemoradiotherapy has been found to allow 78.5 per cent of people with early to intermediate-stage rectal cancer to avoid major surgery and preserve the rectum at 12 months. This compared to 60.6 per cent of patients treated with short-course radiotherapy.

A reduction in severe side-effects was also seen, with Grade 3-4 serious adverse events occurring in eight per cent of organ preservation patients, compared to 19 per cent of patients undergoing total mesorectal excision.

Researchers will continue to track three-year and longer-term survival, recurrence rates and quality of life metrics.

Commenting, professor of clinical oncology at the University of Leeds David Sebag-Montefiore said: “These exciting results are an example of how a smarter, kinder radiotherapy treatment may allow patients to avoid the need for major surgery.” 

What does the research mean for the evolving role of radiotherapy in rectal cancer treatment?

• A shift away from mandatory surgery and greater focus on organ preservation, with radiotherapy emerging as a frontline treatment to shrink tumours
• Reduced complications and toxicity, with fewer adverse events compared to surgery
• Greater focus on response-adapted management, with patients followed closely and clinically evaluated every few months

Additional study value

It’s thought that STAR-TREC is the first randomised trial to compare long-course chemoradiotherapy and short-course radiotherapy with organ preservation in mind for early and intermediate-stage rectal cancer, alongside radical surgery comparators.

At 12 months, organ preservation was more frequent with LCCRT than SCRT, suggesting improved cancer downgrading and early organ preservation. 

Further review over the long term is now necessary for the 30-month end point to determine definitive oncological outcomes.