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Categories: Medicine Rectal cancer Surgery

Doctors more than halve local relapse of rectal cancer

Cancer cellRectal cancer patients who receive a combination of improved surgical techniques and short-course radiotherapy before surgery have a strong chance of remaining cancer-free, according to two articles published in this week’s edition of The Lancet.

The study shows that high quality surgery and a five day course of radiotherapy cuts recurrence rates to just 1%, compared with about 13% with standard surgery alone.

Both reports are based on an assessment of data collected during the Medical Research Council funded CR07 trial and the CO16 trial funded by the National Cancer Institute of Canada.

One report assessed how the amount of tissue removed around the tumour by surgeons affected the rates of rectal cancer recurrence.
The findings, based on 1156 patients from the UK, Canada, South Africa and New Zealand, with operable rectal cancer, shows that surgery rated as ‘good’ that removes the whole of the rectum – known as the ‘mesorectal plane’ - is the most successful.

The results are so convincing that this high quality surgery technique is already being used by surgeons.

“At present, only 50% of rectal cancer surgery is done in the mesorectal plane, suggesting that a further decrease in local recurrence rates might be obtained by improving the plane of surgery… [This can] be achieved through education and surgical tuition,” said Professor Phil Quirke, Yorkshire Cancer Research Centenary Professor of Pathology, a pathologist from the University of Leeds, and lead author of the paper.

The accompanying report, led by Dr David Sebag-Montefiore from St James’s University Hospital in Leeds, compared the effectiveness of short-course pre-operative radiotherapy, with a five week course of radiotherapy and chemotherapy reserved for those patients considered at high risk of the cancer returning. The reason for the latter option was that radiation given in the pelvic area can lead to sexual and bowel problems.

1350 patients were randomly assigned either five daily treatments of radiotherapy followed by surgery, or surgery followed by 25 treatments of radiotherapy and chemotherapy for those at high risk of a local recurrence.

Findings show that after three years 4 % of patients in the radiotherapy group had a local recurrence, compared with 11% of patients in the surgery and selective treatment group.

Richard Stephens from the Medical Research Council Clinical Trials Unit said: “These studies add further weight to the argument that the quality of surgery achieved improves outcomes in rectal cancer patients, and that short-course pre-operative radiotherapy improves them even more, even when good surgery has been performed.”

“The results of the trial mean that patients will now be able to make an informed decision about the benefits and side effects of pre-operative radiotherapy. What the trial clearly shows is that both treatments combined have the best outcome in treating rectal cancer.”

The pathology research was also funded by Yorkshire Cancer Research

Notes to editors
Original research papers:
Preoperative radiotherapy versus selective postoperative chemoradiotherapy in patients with rectal cancer (MRC CR07 and NCIC C016): a multicentre, randomised trial published in The Lancet 2009, 373, 811-21

Effect of the plane of surgery acheived on local recurrence in patients with operable rectal cancer: a prospective study using data from the MRC CR07 and NCIC-CTG C016 randomised clinical trial published in The Lancet 2009, 373, 821-8

The Medical Research Council is dedicated to improving human health through excellent science. It invests on behalf of the UK taxpayer. Its work ranges from molecular level science to public health research, carried out in universities, hospitals and a network of its own units and institutes. The MRC liaises with the Health Departments, the National Health Service and industry to take account of the public’s needs. The results have led to some of the most significant discoveries in medical science and benefited the health and wealth of millions of people in the UK and around the world.

The University of Leeds is one of the largest higher education institutions in the UK with more than 30,000 students from 130 countries and a turnover of £450m. The University is a member of the Russell Group of research-intensive universities and the 2008 Research Assessment Exercise showed it to be among the top UK research powerhouses. The University's vision is to secure a place among the world's top 50 by 2015.

Yorkshire Cancer Research was formed in 1925, to fund research into the cause and cure of cancer. Each year it funds research at its five centres of excellence, based at the universities of Bradford, Hull, Leeds, Sheffield and York and their associated teaching hospitals.


Further information, Please Contact:
To arrange an interview with Richard Stephens or Bob Steele please contact:
the Medical Research Council press office
tel: 020 7637 6011
Out of hours call: 07818 428 297.

To arrange an interview with Professor Phil Quirke please contact:
Leeds University Press Office
tel: 0113 343 8059

Source:University of Leeds

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