2023-06-06 07:54:33
A study presented at the American Congress of Oncology paves the way for a new treatment, equally effective but less toxic, for patients who respond well to pre-operative chemotherapy
Personalize therapy for rectal cancer
choosing, for the individual patient, the one that is most likely to be not only more effective, but also less toxic. this is the objective achieved by the PROSPECT study, presented in the plenary session of the congress of the American Society of Clinical Oncology (Asco), underway in Chicago, and simultaneously published in scientific journals
New England Journal of Medicine
e
Journal of Clinical Oncology
. A step forward destined to change the current standard of care and with a special value for patients with rectal carcinoma: today, in fact, the treatments include a mix of chemotherapy, radiation and surgery which leaves heavy consequences on the daily life of patients, also in terms of incontinence, sexual dysfunction and infertility.
The new strategy illustrated at the American conference marks a turning point because it indicates that in a selected group of patients (for whom chemo is effective) you can not do radiotherapy before surgerywithout compromising the effectiveness of the result, but reducing the side effects that negatively impact the patients’ quality of life.
Cancer on the rise among young people
Being able to improve the quality of life of the sick is even more important in consideration of the fact that this neoplasm, globally declining, is increasing in young people (in America and also in Italy). There are about 9,000 people in Italy who receive the diagnosis of rectal carcinoma every year, which is more common among people aged 60-70, especially males, but for years there has been a progressive growth in cases in the under 50 population, as is also happening for the colon cancer,” he says Philip Pietrantonio, Head of Gastroenterological Medical Oncology at the IRCCS Foundation Istituto Nazionale Tumori di Milano —. Having a less “toxic” strategy is very important for patients’ quality of life e this new strategy set to become the standard of care.
The new studio
The PROSPECT study (phase three, the last before definitive approval of a new treatment) enrolled, between June 2012 and December 2018, 1,194 patients with locally advanced rectal cancer, who were divided into two groups: half underwent the standard treatment, i.e. concomitant chemotherapy and radiotherapy before surgery (which consists in the complete excision of the mesoretum, sparing the anal sphincter); the other half was treated with an innovative strategy that consists of an enhanced scheme of chemotherapy combined with selective use of standard chemoradio, always pre-operative. And the results show that, in patients who respond well to chemotherapy, radiotherapy can be safely omitted before surgery: the five-year survival results after treatment are, in fact, substantially the same.
Personalized care
Radiotherapy is valuable for reducing the risk of the tumor returning with a recurrence, but in many patients it involves significant toxicityeven long-term, such as faecal and urinary incontinence, sexual dysfunction and infertility in women – he explains Sara Longardi, Acting Director of Oncology 3 at the Veneto IRCCS Institute of Oncology in Padua —. For this reason, the aim was to avoid irradiating this area whenever possible. Because we are talking about people with a locally advanced neoplasm in which the goal is healingit was necessary to be sure of guaranteeing the reduction of toxicity and the efficacy of the therapy in reducing the tumor, but also long-term goals such as limit the risk of local recurrence and distant metastases. So the authors, in the experimental group, decided to proceed step by step: they adopted more powerful chemotherapy (a combination known as FOLFOX, based on the drugs 5-fluorouracil, oxaliplatin and leucovorin) instead of the standard (the chemotherapy drugs 5-fluorouracil and capecitabine plus radiotherapy). Subsequently, based on the results obtained in each patient, they decided whether to refer the individual patient to the operation or whether to subject him to radiotherapy first.
In short, the therapeutic strategy has been personalized by modulating its intensity and considering both the initial stage of the tumor and the response obtained after the first treatment.
Therapies today in Italy
Rectal cancer is difficult to treat due to the area of the body where it occurs, so it’s important to do everything possible to prevent it — remember Philip Pietrantonio, who is also a member of the board of the Italian Association of Medical Oncology (Aiom) —. And crucial to be followed in centers with experience by a multidisciplinary teammade up of several experts, who thoroughly evaluate various aspects before choosing among the possible therapeutic options.
In early stage disease the standard treatment radical surgery which however, especially in cases in which it is very low and close to the sphincter, can be burdened by important long-term sequelae with an impact on the quality of life of patients such as faecal incontinence, chronic diarrhea and sexual disorders, as well as sometimes from the need for a definitive colostomy. Operable but locally advanced patients (such as those in the PROSPECT study), are usually adopted pre-surgery treatments which allow both to make the operation more radical and effective, and to reduce the risk of subsequent recurrences local (pelvic level) or in other organs (distant metastases).
Symptoms and prevention
Today in very selected patients we can hypothesize less invasive or even surgical procedures avoid the scalpel if the tumor “disappears” completely with the first cycle of therapies, providing for tight controls for the first three years – specifies Lonardi -. With the progress made over the years we have passed the threshold of 60% of patients alive five years after diagnosis, but there is much to do. Unfortunately, the symptoms are often the expression of an already advanced disease, which is why joining the screening with the Sof test and arriving at an early diagnosis is a real lifesaver.
Not infrequently in the initial phase, rectal cancer does not give specific warnings: in any case, it is advisable never to neglect – when they persist – rectal bleeding and blood in the stoolas well as anemia, abdominal pain or cramps, diarrhoea, constipation, a sense of incomplete emptying of the intestine after defecation.
June 6, 2023 (change June 6, 2023 | 07:51)
© Time.News
#patients #avoid #radiotherapy #time.news