Novel radiotherapy may save increasingly many rectal cancer patients from surgery and stoma
Every year, some 730,000 new rectal cancers are diagnosed worldwide. The treatment of rectal cancer often involves surgery to remove part or all of the rectum. Surgery is an effective treatment for cancer, but it can result in a permanent stoma as well as long-term complications that affect bowel function, urination and sexuality.
“Curing cancer is always our primary goal, but we also want to preserve the best possible quality of life. If a tumour can be completely eradicated without removing the rectum, the patient may – in the best-case scenario – avoid both major surgery and a stoma," says Professor Toni Seppälä from Tampere University and Tays.
Radiotherapy delivered directly next to the tumour
Tays is the first hospital in Finland to introduce contact radiotherapy for rectal cancer. The medical term for this treatment is high-dose-rate brachytherapy, or HDR brachytherapy. The treatment delivers radiation directly to the tumour via a device inserted in the rectum.
The advantage of the method is that a high dose of radiation can be targeted at the tumour while minimising radiation exposure in the surrounding healthy tissues. The treatment utilises an iridium-192 radiation source.
The treatment is not suitable for all patients with rectal cancer. The eligibility of patients is assessed by a multidisciplinary team that includes, among others, colorectal surgeons, oncologists, radiation oncologists and radiologists.
One important patient group comprises frail and elderly people for whom major rectal cancer surgery may be particularly burdensome or even pose an excessive risk. It is estimated that there are more than 100 such patients in Finland every year.
Organ preservation is becoming increasingly important in rectal cancer treatment
In recent years, a significant shift in thinking has taken place in the treatment of rectal cancer. International studies have shown that, in some patients, the tumour disappears completely following radiotherapy and anti-cancer medication. In such cases, careful monitoring may be considered as an alternative to surgery.
This treatment strategy is known as organ-preserving treatment or the watch-and-wait approach. Patients are monitored closely so that any residual or local regrowth of the tumour can be detected early and treated surgically.
Tumour-targeted brachytherapy aims to increase the number of patients who achieve a complete clinical response and can safely retain their rectum.
“The goal is not to treat the cancer less intensively, but more precisely. We want to identify a treatment that is sufficiently effective for each patient while avoiding treatments and side effects that would yield no additional benefit," says Seppälä.
Tampere leads national research on organ-preserving treatment
The introduction of the new treatment is linked to the NORPPA research programme coordinated by Tampere University and Tays, which is developing new organ-preserving treatment approaches for rectal cancer. The research network includes hospitals from across Finland and Estonia.
The NORPPA-2 study, due to begin in 2027, will investigate the effectiveness of HDR brachytherapy as part of an organ-preserving treatment strategy for rectal cancer. The study will examine how effectively tumour eradication can be achieved by intensifying local radiotherapy and how many patients can avoid major surgery as a result.
If local radiotherapy proves sufficiently effective against the tumour, the researchers will also investigate whether some patients could be treated without chemotherapy.
If the study confirms the effectiveness and safety of the treatment, the new method could expand the group of rectal cancer patients who may, in the future, be offered organ-preserving treatment as an alternative to surgery.
Further information
Professor Toni Seppälä
toni.seppala [at] tuni.fi (toni[dot]seppala[at]tuni[dot]fi)
+358 44 472 2846
