Coglasno five-year results of a clinical trial, the local organ-removal is possible for certain patients with colon cancer, which show a good clinical response after chemotherapy.

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"Physicians should consider the conservation authorities or as a new standard for rectal cancer, as cancer or safe option, which should be offered to the patient," - says Dr. Eric Rull of Haut-Leveque Hospital in France. Results of a randomized study GRECCAR 2, which compared the local excision and total mesorectal excision for rectal cancer, showed no significant differences between the groups in mortality, relapse or side effects.

In the new analysis, Dr. Rull and his colleagues compared the relapse, metastatic disease and survival after five years at the local excision (74 patients) and total mesorectal removal (71 patients). The number of patients with metastatic disease was identical: 13 in a group with a local removal and 13 in the group with complete removal of mesorectal. Groups of local and complete removal did not differ in overall five-year survival (84% vs. 82% respectively), disease-free survival (70% vs. 72%) or a specific cancer mortality (10% versus 7%).

"This discovery will change the treatment of colon cancer - says Dr. Rull. - Patients should be aware of the new opportunities. " Dr. Fahima Doss from St. Michael's Hospital in Toronto, Canada, says: "On the basis of previously published results, it is not surprising that in this study reported similar results for patients with local excision and radical surgery. Individual patients may avoid radical rectal surgery. However, a more careful look at the results of the study were less encouraging: when you study the outcomes of patients based on treatment, apparently, a clinically significant increase in cancer recurrence and decreased survival observed among patients, which makes the local excision. The study is not sufficiently complete to detect statistically significant differences in these results. Local removal is not yet ready for clinical use in this patient group. It jeopardizes the oncological outcome, and we know from the previous publication the authors, that patients who undergo local excision and subsequently require radical surgery, a very high incidence. The current standard of care for most patients with colorectal cancer is radical surgery. However, currently estimated new approaches that can save the patient from surgery and related complications. Promising areas include general neoadjuvant treatment for patients with tumors that demonstrate a complete clinical response. However, the safety and efficacy of these approaches need to be confirmed in randomized clinical trials. "

Source: https://www.medscape.com/viewarticle/925675

Date of publication: 
Monday, March 2, 2020