Impact Spotlight: The AGITG/TROG 01.04 trial

Two options are better than one

Rectal cancer affects more than 4,600 Australians every year. With 30% of people not surviving beyond five years after a rectal cancer diagnosis, any and all research into this disease is vital for patients affected by it. In patients with localised rectal cancer, the standard treatment would be either a course of radiotherapy or chemotherapy before cancer surgery procedures, but which pre-surgery treatment was most effective?

That is what the AGITG/TROG 01.04 trial aimed to uncover. The AGITG collaborated with the Trans-Tasman Radiation Oncology Group (TROG) to conduct a study that compared the short-course (five days) radiotherapy treatment with the long-course (five to six weeks) chemoradiotherapy before surgical removal of the cancer.

As both treatments were considered the standard of care and had been shown to improve survival outcomes having both been used since 2001, it was unclear which form of treatment was better at reducing the risk of cancer recurrence.

Across Australia and New Zealand, 326 patients were enrolled into the trial. The results revealed that at five years after treatment, the local recurrence rates were similar between both treatment groups (short and long courses). The study also showed no differences in the risk of cancer spreading elsewhere in the body or in life expectancy between the two treatments.

Study Chair Associate Prof Sam Ngan was pleased with the study results, revealing that both forms of treatment are effective in the targeting rectal cancer.

“When delivered prior to cancer surgery, both short and long-course treatments are effective in the management of localised T3 rectal cancer. They are similar in terms of tumour control, side effects and quality of life,” Associate Professor Ngan said.

This means that short-course radiotherapy may be an appropriate option for patients who cannot tolerate chemotherapy, and this treatment is easier to deliver. This allows cancer doctors to tailor treatment decisions for individual patient needs.

“A five-day short course treatment with radiation alone, is less resource intensive and is more convenient for the patient. It has become the treatment of choice in the current COVID-19 pandemic.”

The results of this trial have not only helped the design of other studies in this area, but have given patients tailored options when it comes to their treatment, and given both doctors and patients definitive answers on the effectiveness of their course.