Standard care less help in younger rectal cancer patients

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Chemotherapy and radiation don't improve survival chances in patients younger than 50 when combined with surgery, a study found.

A study published in the journal Cancer this week found that chemotherapy and radiation don’t improve chances of survival in patients younger than 50 when combined with surgery.

University of Florida Health surgeon Dr. Atif Iqbal worked on the database study, examining past cases of rectal cancers and which treatments prolonged a patient’s life.

The standard of care for rectal cancer patients is surgery plus chemotherapy and radiation therapy, Iqbal said.

“This is really exciting because this highlights something that we’ve never previously seen, and it could be practice-changing,” he said.

Iqbal specializes in colorectal surgery.

Researchers don’t yet know why chemotherapy and radiation don’t have the same effect on people younger than 50 than people 50 or older, Iqbal said, although there are differences in the genetic basis of the disease.

“We know we don’t know all about the different genes that cause colorectal cancer,” he said. ““There’s something else going on that we don’t know about.”

He added that there’s been a rise in younger colorectal cancer patients, and he believes it’s an increase in incidents of cancer rather than an increase of screening.

"We are noticing more and more younger individuals coming in with more and more aggressive disease," Iqbal said.

In May, the American Cancer Society announced that it would recommend people with average risk of colorectal cancer should get screened regularly at age 45 instead of age 50.

Iqbal's study isn’t enough to change the standards of care for younger rectal cancer patients, he said, and further research and random clinical trials are needed to decide how to best treat these younger patients. In the future, he said, researchers and physicians can explore not using chemotherapy and radiation therapy.

This database study does offer a trajectory that randomized control trials can take in the future, and it gives physicians more room to treat younger patients as an individual population.

“This highlights the need to treat these younger patients as a separate group,” Iqbal said.

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