Non surgical treatment of rectal cancer

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Published: 23 Nov 2016
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Prof Arthur Sun Myint - Clatterbridge Centre for Oncology NHS Foundation Trust, Birkenhead, UK

Prof Sun Myint speaks with ecancertv at NCRI 2016 about non surgical treatment of rectal cancer, and how he has successfully treated over 1,000 patients using this technique.

The patients have been mostly elderly with early and more advanced tumours, who are not suitable for surgery. 



We were interested in non-surgical treatment of rectal cancer so I led the team from Clatterbridge and went to Lyon in France in 1992 and we set up the first facility in this country in 1993. So we have now treated over a thousand patients with this technique. These are mainly elderly patients who are not suitable for surgery. So over the years we have accumulated a lot of experience and what we were trying to do is to start presenting our data and this is a selected 200 patients, data on 200 patients, that we have presented as a poster. Fortunately I was asked to do an oral presentation as well by the Royal College of Radiologists.

These patients are elderly patients, some of them are early tumours, some of them are more advanced tumours but they have the external beam radiation which is what people would do if they’re not fit for surgery. Then usually there is a residual tumour and most of the time they don’t offer any additional treatment in which case most of the patients will have a recurrence within a year or two years and they went on to palliative care. But with our treatment, with the minimal residual disease we can show that we can improve the local control considerably. If you just give external beam there’s about 30-40% risk of local regrowth, as we call it; by doing this contact radiation which is a superficial X-ray, 50kV X-ray treatment, we can reduce those regrowths down to about 11% which is considerable.

What are the implications?

The implications, there are several actually, as I highlighted in my poster. Initially there is a growing, aging population in the UK and not just in the UK but in Europe as well. Secondly, there is a lot of publication on the harm of surgery for these elderly patients by several big centres including several from the UK. Thirdly, and most importantly, increasingly early stage rectal cancers are being diagnosed through the National Bowel Cancer Screening Programme which we’ve had in this country for nearly ten years. These patients are being offered a treatment that goes back a hundred years – doing a major surgery, ripping the rectum out and then giving a permanent stoma in about 40% of cases. This is clearly unacceptable so my treatment would improve the local control by reducing these local regrowths after external beam and avoid these elderly patients who are at the high risk of surgical mortality and morbidity, giving them a better quality of life and survival for the duration of their survival. The majority of these patients do not die from their cancer, they die from other medical comorbidities which most of them have.

Is this available through the NHS?

For me NICE has now approved this treatment and they have published a recommendation in September of 2015, SIP532, which obviously has helped these elderly patients because in most of the colorectal MDTs they don’t regard Papillon as a standard of care, the standard of care is still surgery and they persuade those patients to have surgery which they all like to avoid. By doing this treatment we were able to give them an option. The beauty of my treatment is if it doesn’t work, if there is a residual tumour at the end of the treatment, they can still have surgery and then get the cancer cleared.

Any final thoughts?

In the current national and international guidelines there is no provision for this type of treatment. All the guidelines state is that standard of care is surgical treatment which has got the high mortality and morbidity in elderly patients. So I’d like to persuade the powers that be, the policy makers, that the next step should be an option for these elderly patients for the treatment of these early rectal cancers so that they can avoid the surgical harm.