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Less Invasive Treatment Feasible for Early-Stage Rectal Cancer

TUESDAY, Dec. 15, 2020 -- Short-course radiotherapy followed by transanal endoscopic microsurgery for early-stage rectal cancer (TREC) achieves a high level of organ preservation and improved quality of life, according to a study published online Dec. 10 in The Lancet Gastroenterology & Hepatology.

Simon P. Bach, M.B., B.S., M.D., from the Cancer Research U.K. Clinical Trials Unit in Birmingham, and colleagues conducted a randomized, open-label feasibility study involving participants with rectal adenocarcinoma, stage T2 or lower, with a maximum diameter of 30 mm or less. Participants were randomly assigned to undergo either organ preservation with short-course radiotherapy followed by transanal endoscopic microsurgery (27 patients) or total mesorectal excision (28 patients).

The researchers found no deaths within 30 days of initial treatment; one patient assigned to organ preservation died within six months following conversion to total mesorectal excision. Eight patients (30 percent) randomly assigned to organ preservation converted to total mesorectal excision. Serious adverse events occurred in 15 and 39 percent of patients randomly assigned to organ preservation and total mesorectal excision, respectively. A complete response to radiotherapy was achieved by 30 percent of patients assigned to organ preservation. Compared with patients randomly assigned to total mesorectal excision, those assigned to organ preservation showed improvements in patient-reported bowel toxicities and quality of life and function scores, which were sustained over 36 months.

"TREC provides evidence to support further evaluation of organ preservation strategies that incorporate short-course radiotherapy as an alternative to radical surgery for early-stage rectal cancer," the authors write.

Several authors disclosed financial ties to the pharmaceutical industry.

Abstract/Full Text

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Posted: December 2020

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