In recent years, the treatment approach for non-locally advanced rectal cancer has undergone significant changes. Traditionally, short-course radiotherapy was given as a first step to reduce the risk of local recurrence. However, advancements in diagnostic imaging and surgical techniques have prompted a reevaluation of this practice.
The study, by a national network, the Dutch Snapshot Research Group, and led by Cancer Center Amsterdam researchers Miranda Kusters, Sanne Hazen, Tania Sluckin and Pieter Tanis, compared the outcomes of two cohorts of patients in the Netherlands, who underwent surgery for primary non-locally advanced rectal cancer in 2011 and 2016, a total of 2,775 individuals.
The data revealed a significant decrease in the use of neoadjuvant radiotherapy, from 87% in 2011 to 37% in 2016. This reduction was not associated with an increased rate of local regional recurrence, which remained stable at around 5.5%. Furthermore, an improvement in overall survival was observed, increasing from 79.6% to 86.4%, accompanied by a decrease in non-cancer related mortality.
Diagnostic and Surgical Progress Matters
This shift in treatment strategy stems from improved diagnostic capabilities, notably the routine use of Magnetic Resonance Imaging (MRI), and advancements in surgical quality. Large studies from the 1990s established the routine use of radiotherapy based on the perceived benefits in preventing local recurrence. However, smaller, more recent studies have demonstrated low local recurrence rates with upfront surgery alone, thanks to precise MRI assessments. Consequently, the Dutch guideline revision in 2014 marked a significant policy shift from the routine application of radiotherapy to a more selective approach, based on tumor stage.
The study's findings suggest that with the refined use of MRI for staging and the continued improvement in the quality of rectal cancer surgery, pre-surgical radiotherapy can safely be omitted for most cases of localized rectal cancer. This approach not only preserves the efficacy of cancer treatment but also reduces the burden of treatment-related side effects on patients.
“These results highlight how advancements in diagnostic and surgical techniques can lead to more precise, less invasive treatment strategies and improve patient outcomes,” says Sanne Hazen, PhD-candidate at Amsterdam UMC.
The JAMA Oncology publication is a chapter in Sanne's PhD thesis. She will defend her thesis at the Agnietenkapel of the University of Amsterdam on April 25.
For more information, contact Miranda Kusters, or read the scientific publication:
Hazen SJA, Sluckin TC, Intven MPW, et al. Abandonment of Routine Radiotherapy for Nonlocally Advanced Rectal Cancer and Oncological Outcomes. JAMA Oncol. 2024;10(2):202–211. doi:10.1001/jamaoncol.2023.5444
Involved Researcher at Cancer Center Amsterdam:
Sanne-Marije J.A. Hazen
Tania C. Sluckin
Wernard A.A. Borstlap
Tineke E. Buffart
Susan van Dieren
E. Debby Geijsen
Roel Hompes
Karin Horsthuis
Jurriaan B. Tuynman
Pieter J. Tanis
Miranda Kusters
Funding
This study was funded by the Dutch Cancer Society (KWF), project leader dr. M. Kusters grant 12768.
Text by Laura Roy.
This article was created for Cancer Center Amsterdam.
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