Moving forward with organ preservation in rectal cancer
Menée au Royaume-Uni auprès de 55 patients atteints d'un adénocarcinome rectal de stade T2 ou moins et présentant un diamètre maximal de 30 mm, cette étude multicentrique évalue la faisabilité d'une stratégie de préservation des organes comportant une radiothérapie de courte durée suivie d'une microchirurgie endoscopique transanale après 8 à 10 semaines
The concept of radical cancer surgery is about 150 years old and was developed at a time when patients presented with large tumours and surgery was the only treatment option available. The belief that the more extensive the operation, the greater the chance for cure peaked at the end of the first half of the 20th century. Gradually, however, surgeons tried to maintain the same oncological outcomes with less mutilating resections, often combining surgery and radiotherapy, and sometimes even with radiotherapy as the primary approach and surgery as the backup plan. This approach has improved the quality of life of many patients with, for instance, breast cancer, head and neck cancer, limb sarcoma, and anal cancer. Management of rectal cancer has been late to adopt less radical approaches to preserve quality of life, with the main research focus of the past 40 years being on improving oncological results with different combinations of surgery, radiotherapy, and chemotherapy, rather than on quality of life. But that is changing, much to the delight of patients, who highly value a good functional outcome as an important treatment goal, often more than clinicians are aware of. Against this background, the report in The Lancet Gastroenterology & Hepatology by Simon Bach and colleagues on the TREC study, a small randomised, open-label trial on organ preservation in rectal cancer, deserves attention.
The Lancet Gastroenterology & Hepatology , commentaire, 2019