Rectal Cancer Radiation Therapy: When is it required? (4)

Learn more and get a better rectal cancer treatment plan with top experts. Visit our Online Colorectal Cancer Expert Center at https://diagnosticdetectives.com/colo...

Exclusive interview / Dr. Anton Titov MD and Professor Dr. Torbjorn Holm MD, world's leading rectal cancer treatment surgeon.

- Treating cancer is a multimodality exercise by a team of medical oncologists, cancer surgeons, radiation oncologists. You have extensive experience in combining radiation therapy with the surgical excision in rectal cancer. Please speak about your experience in combining radiotherapy with surgical therapy in rectal cancer patients. Again we have to remember our history. Rectal cancer treatment was not good in Sweden and internationally until the mid-90s or late 1990s. We have to remember that the risk of local recurrence in the pelvis was about 25% to 30%, even if the surgeons thought they had done a radical operation. Risk of rectal cancer local recurrence was very high. In 1980 we started a clinical trial in Stockholm to learn how we could improve rectal cancer recurrence rates. We started "Stockholm trials" of radiotherapy in rectal cancer. Then we started the Swedish rectal cancer trial. We randomized rectal cancer patients to have surgery directly or to have radiation therapy followed by surgical operation. We did these clinical trials because surgical treatment results were so poor. We could show that giving the patient with rectal cancer radiation therapy before surgery reduced the risk of local recurrence of rectal cancer by 50%. So risk of rectal cancer recurrence went from 25% down to 12% with preoperative radiotherapy for rectal cancer. But then Professor Bill Heald taught us how to do Total Mesorectal Excision for rectal cancer. And then we showed that combining radiation therapy with TME surgery for rectal cancer reduced local recurrence rates to less than 5%. Then we have reassessed treatment options. We now think that the most important option to treat rectal cancer is surgical operation. If you do a good surgery, especially for early rectal cancer, you don't need radiation therapy. So the pendulum has come back again. Before we thought that every patient had to have radiation therapy. Now we realize that with good surgery you don't need to give radiotherapy to everybody with rectal cancer. You need to give radiation therapy to those rectal cancer patients who have locally advanced rectal cancer. Today the practice of rectal cancer treatment is the following: if you have a more advanced rectal cancer that invades mesorectal fascia, or if you have several lymph nodes involved with cancer, then you should give the patient radiotherapy. And often you have to combine radiotherapy with chemotherapy. So you give them radiochemotherapy first and then do operation to resect rectal cancer. If you have a superficial rectal cancer, if it's easy to operate on, you don't need to give patient radiotherapy. Because radiotherapy is also inducing in a lot of complications, both early and late complications. Radiation therapy is a powerful tool for the advanced rectal cancer cases. But if you don't have to use radiotherapy, you shouldn't use it. Because the patient may suffer from it, in the long term and in the short term.

Rectal Cancer Radiation Therapy: When is it required? (4) top doctors mexico
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