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Rectal cancer – Practice changing research


By: Dr. Nilesh D. Mehta

In 2023, it is expected that nearly 800,000 people around the world will be diagnosed with rectal cancer, and about half of them will have a more advanced form of the disease. For the past 20 years, the standard treatment has involved giving patients radiation therapy to the pelvic area along with chemotherapy before surgery.

Recently, doctors have been wondering if there might be a different way to treat rectal cancer that doesn’t involve radiation and chemotherapy. An extensive study called the PROSPECT clinical trial was carried out to explore this idea. It involved 1,194 patients with rectal cancer from the USA, Canada, and Switzerland between 2012 and 2018.

In this study, some patients got the standard treatment with radiation and chemotherapy, while others got six cycles of chemotherapy with a mix of drugs called FOLFOX. They did not include patients with very high-risk rectal cancer in the study. The results showed that the group receiving FOLFOX chemotherapy and selective radiation use was a safe and effective treatment option, especially for patients who could have surgery to save their sphincter muscles. This means that radiation therapy before surgery might not be necessary for some rectal cancer patients.

Until now, most rectal cancer patients have received radiation as part of their treatment plan. However, with this study’s results, doctors may reconsider whether radiation is needed for all patients with rectal cancer. This research suggests that patients who can have sphincter-saving surgery might not require radiation therapy. Instead, they can receive three chemotherapy drugs, FOLFOX (fluoropyrimidine, oxaliplatin, and leucovorin).

Experts believe this new information could change how rectal cancer is treated, with radiation therapy reserved for more advanced cases. Newer drugs are being utilised in cancer treatment, and the promising use of immunotherapy in several cancer treatments has completely changed the landscape of cancer management. The over-dependence on chemotherapeutic medications from the past is now increasingly being replaced with reliance on immunotherapeutic drugs and targeted therapy. Over the last decade or so, many more unique cancer treatments have been a boon to our patients affected by cancer.

Dr. Nilesh D Mehta



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