Jeff Ryckman, Associate Professor of Radiation Oncology at WVU Medicine Camden Clark Medical Center, shared on X:
“STAR-TREC (Lancet Oncol, published this week): one of the more underappreciated design choices here is the RT target volume itself. Both arms used a mesorectal-only CTV, no elective internal/external iliac nodal coverage at all, roughly half the size of a standard locally advanced rectal field. Anal canal sparing:
For low tumors where the CTV dips into the anal canal, only the internal sphincter gets captured, capped at 1cm. External sphincter and levator ani are deliberately spared throughout.
Makes sense given how rarely early-stage, mrN0 disease fails nodally, but this is the first prospective trial to actually test the approach rather than assume it.
I’d be curious how much of the QoL advantage over TME comes from the smaller field versus avoiding surgery altogether. HT
Krishan Jethwa for highlighting this and other interesting aspects of the study, including selective TAE at 16–20 weeks for near-CR, during our discussions after ASCO 2022. “
Quoting The Lancet Oncology:
“Online now: Chemoradiotherapy versus short-course radiotherapy for response-adapted organ preservation in early-stage and intermediate-stage rectal cancer (STAR-TREC): 12-month results of a randomised, phase 2/3 trial”
Title: Chemoradiotherapy versus short-course radiotherapy for response-adapted organ preservation in early-stage and intermediate-stage rectal cancer (STAR-TREC): 12-month results of an international, multicentre, open-label, parallel-group, randomised, phase 2/3 trial
Authors: Simon P Bach, David Sebag-Montefiore, Victoria Homer, Alexandra Gilbert, Ane Appelt, Ian Geh, Geerard L Beets, Jacobus Burger, Eva Angenete, Gunnar Baatrup, Karen-Lise Garm Spindler, Karin Haustermans, Fabian Holman, Ellen M Kerkhof, Emily Lam, Stephan Korsgen, Anna Martling, Albert Wolthuis, Issam Al-Najami, Pehr Lind, Femke P Peters, Mark Teo, Nicholas P West, Simon Gates, Corrie A M Marijnen, Johannes H W de Wilt
Read The Full Article
You can also read:ARISTOTLE Post-Hoc Analysis: AI-Derived Tumour Cell Density in Rectal Cancer
