New treatment helps patients with rectal cancer avoid major surgery and side effects

New research into early-stage rectal cancer could transform how patients are treated for the disease, according to a landmark trial funded by Cancer Research UK and Stand Up To Cancer.

Rectal cancer is a type of bowel cancer. People with this type of cancer will generally undergo major surgery to remove their whole rectum, which can lead to significant side effects like bowel dysfunction, sexual and urinary problems, and a permanent colostomy bag.

Now, the latest result from the STAR-TREC trial could change that – and bring about enterprising new treatment options for people affected by rectal cancer.

Researchers at UCL, the University of Birmingham and the University of Leeds found that chemoradiotherapy (having radiotherapy at the same time as chemotherapy) and minor surgery only when needed allowed 4 in 5 patients to keep their rectum and avoid significant side effects.

Michelle Mitchell, Cancer Research UK’s chief executive, says: “This breakthrough could be life-changing for thousands of people.”

Who is STAR-TREC for?

Man standing in dappled light in a garden. — Brian took part in our STAR-TREC trial.

Around 4,100 people in England are told they have early-stage rectal cancer each year – people like Brian, a 69-year-old from Birmingham, who went his GP after he noticed a change in his bowel habits and bleeding when he went to the toilet.

Brian assumed he’d be diagnosed with haemorrhoids, but instead was sent for an emergency endoscopy that identified a suspicious lump just inside his rectum. A biopsy of the lump revealed that he had rectal cancer.

“The diagnosis was totally unexpected,” he says. “I was shocked but accepting of it. I knew worrying wouldn’t help, so I just focused on living life. Two weeks later, my consultant told me about a clinical trial called STAR-TREC.”

Brian was one of over 500 patients recruited across five countries for the trial.

He didn’t feel daunted by the prospect of joining it: “My consultant explained that the usual treatment would be surgery and it was highly likely I’d be left with a permanent colostomy bag. The decision wasn’t difficult, so I said, ‘sign me up.’ My view was to go for the trial as I couldn’t be any worse off if nothing worked, and it might be useful for future cancer patients.”

During the trial, Brian had five days of intensive radiotherapy. Fortunately, he experienced minimal side effects beyond a little nausea and some lower back pain, which cleared up quickly.

Things are only impossible until they’re not

The trial compared the current surgical treatment method with two different organ-preserving treatment approaches – five weeks of chemoradiotherapy or five days of radiotherapy.

After 12 months, the research team found that five weeks of chemoradiotherapy was more effective than the other two treatment approaches. Patients in this group were less likely to need radical surgery than those who had five days of radiotherapy, and experienced minimal side effects.

The researchers who worked on this trial are pleased with the outcome.

David Sebag-Montefiore, one of STAR-TREC’s co-chief investigators and Professor of Clinical Oncology at the University of Leeds, says: “These exciting results are an example of how a smarter, kinder radiotherapy treatment may allow patients to avoid the need for major surgery.” 

What comes next – and how can we ‘Make it so?’

The research team will follow patients for the next three years, to monitor whether the cancer is more likely to come back without radical surgery, and whether there’s a difference in survival.

Simon Bach, co-chief investigator of the trial and Professor of Colorectal Surgery at UCL, says: “The next step is to confirm these results hold over the longer term, and then to make sure the approach is available to every patient who could benefit.” 

And what’s next for Brian?

Well, since he finished participating in the trial, CT scans, MRI scans and endoscopies have all shown no trace of cancer.

He believes the treatment he received has allowed him to enjoy a better quality of life than he may have been able to have if he’d had standard treatment – so he’s getting back to enjoying his passions, like supporting Millwall Football Club, and travelling. 

Brian says, “I’m a massive fan of clinical trials. They can be a real game-changer for people like me. Success stories like mine wouldn’t be possible without research into better and kinder treatments.” 