A new treatment approach for people with early-stage rectal cancer could change the way the disease is treated. Results from the international STAR-TREC trial suggest that combining chemotherapy and radiotherapy may allow many patients to avoid major surgery and keep their rectum. The study found that four in five patients treated with chemoradiotherapy were able to avoid removal of the rectum after 12 months. The trial, involving more than 500 patients across five European countries, tested treatments designed to preserve the rectum while still controlling cancer.

The findings have been described as potentially "life-changing" because major rectal surgery can cause long-term problems with bowel function and sexual and urinary health, and some patients may need a permanent colostomy bag. The findings do not mean that surgery is no longer needed for rectal cancer. Instead, they suggest that some selected patients may have another option. In the STAR-TREC trial, patients received either five weeks of chemoradiotherapy or a shorter five-day course of radiotherapy. Their response was then closely monitored, with major surgery reserved for people whose tumours did not shrink enough. Smaller areas of remaining cancer could also be treated with a less invasive, rectum-preserving operation.

What Is Rectal Cancer?

Rectal cancer is a type of bowel cancer that develops in the rectum, the lower part of the large intestine. Treatment depends on factors such as the size and location of the tumour, whether it has spread and how advanced it is.

For many patients with early or intermediate-stage rectal cancer, the standard approach has traditionally involved an operation called total mesorectal excision, or TME. This is a major procedure in which the rectum and surrounding tissues are removed to get rid of the cancer. While it can be an effective treatment, it can impact the quality of life.

Why Is Avoiding Major Surgery Important?

Removing the rectum can affect how a person passes stools and manages their bowel movements. Some patients can experience long-term bowel problems. Surgery can also affect sexual and urinary function.

Another major concern is the possibility of needing a permanent colostomy. A colostomy involves bringing part of the bowel through an opening in the abdomen, allowing waste to leave the body into a bag. Avoiding these complications, when it is safe to do so, could make a significant difference to a patient's daily life.

What Did The New Treatment Involve?

The STAR-TREC trial tested an approach called organ preservation. Instead of automatically sending patients for major surgery, doctors first used treatment designed to shrink or eliminate the tumour.

One group received five weeks of chemoradiotherapy. This means chemotherapy and radiotherapy were given as part of the same treatment plan. Another group received a five-day course of radiotherapy.

Patients were then assessed to see how well the tumour had responded. If the cancer had disappeared or shrunk sufficiently, major surgery could be avoided. If cancer remained, patients could undergo further treatment, including a smaller operation to remove remaining disease. Radical surgery was used when the tumour did not respond sufficiently to the organ-preserving treatment.

What Did The Trial Find?

The results were particularly encouraging for the chemoradiotherapy group. After 12 months:

  • Four in five patients receiving chemoradiotherapy were able to keep their rectum.
  • Surgery-free survival was estimated at 78.5% with chemoradiotherapy.
  • The corresponding figure with short-course radiotherapy was 60.6%.
  • More than 500 patients took part in the wider trial across England, the Netherlands, Denmark, Belgium and Sweden.

These numbers suggest that chemoradiotherapy may be a stronger option for organ preservation than short-course radiotherapy alone in selected patients.

Does This Mean Rectal Cancer Surgery Can Be Avoided?

Not for everyone, the treatment is for people whose cancer is suitable for an organ-preserving approach. Doctors need to carefully assess the tumour using scans, examinations and other tests before deciding whether this strategy is appropriate.

Patients also need close follow-up after treatment. Even if the tumour appears to have disappeared, doctors must continue checking for signs that the cancer has returned. If the cancer does come back or does not respond adequately, surgery may still be required.

The STAR-TREC findings therefore represent an important shift in the treatment of selected early-stage and intermediate-stage rectal cancers. The goal is not simply to treat the cancer, but to do so while preserving as much normal body function as safely possible.

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