Pre-Surgery Radiation Rises to 42% in Rectal Cancer Treatment

Rectal cancer treatment in South Korea has shifted away from radiation after surgery toward radiation and chemotherapy delivered before the operation, according to a 15-year review of patient records. The use of minimally invasive surgery and precision radiation also expanded over the period, and survival rates improved alongside the changes.

A team led by Professor Jang Jeong-yun of the department of radiation oncology at Konkuk University Medical Center analyzed the records of 6,314 patients with non-metastatic rectal cancer treated with curative intent at Samsung Medical Center between 2008 and 2022, medical industry sources said on the 18th. The findings were published in the international journal BMC Cancer.

The researchers divided the study period into five three-year intervals to track changes in treatment. The share of patients who received radiation or chemoradiation before surgery rose to 42.4% in 2020-2022 from 25.5% in 2008-2010. Over the same period, the share of radiation patients who received it as adjuvant therapy after surgery fell to 9.4% from 40.0%.

Surgical methods also changed. The share of minimally invasive procedures, including laparoscopic and robotic surgery, expanded to 91.0% from 44.5%. Use of intensity-modulated radiation therapy, which concentrates radiation on the tumor while limiting exposure of surrounding healthy tissue, increased along with the oral chemotherapy drug capecitabine.

The five-year survival rate for all patients was 87.6%. The standardized mortality ratio, which compares the risk of death with that of the general population, declined to 3.33 in 2020-2022 from 5.57 in 2008-2010, indicating a narrowing gap in mortality risk toward the end of the study period.

The researchers cautioned that while the changes in treatment and the improvement in survival occurred at the same time, the data cannot establish that any particular therapy raised survival rates. The study was observational and based on actual clinical records, in which treatment choices vary according to the stage of disease and the patient's overall condition.

"The significance lies in examining shifts in treatment strategy together with survival outcomes, using long-term clinical records from more than 6,000 patients," Jang said. "We need to keep advancing multidisciplinary treatment strategies tailored to each patient's condition."