"[The increased dose] is safe and reduces the risk of the cancer coming back to less than 5 percent," said Gerard. Rectal cancer that returns after surgery is often incurable, according to Gerard.
The ACCORD 12 trial involved 598 patients with locally advanced rectal cancer, and researchers aimed to find the most effective and safe preoperative treatment for rectal cancer by comparing a combination of two different chemotherapies and two different radiation doses. Patients were randomized to receive either Cap45 (chemotherapy, capecitabine, and radiation treatment at 45 Gy) or Capox50 (chemotherapies, capecitabine and oxaliplatin, along with radiation at 50 Gy).
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The only variable that increased tumor sterilization was the increase of radiation dose from 45 to 50 Gy in five weeks, said Gerard.
"The results of this trial, when analyzed together with the Italian STAR01 and the American NSABP R04 randomized trials, bring solid scientific evidence that a 'CAP50 regimen' should be the standard treatment for locally advanced rectal cancer. Using capecitabine avoids the intravenous injection of fluorouracil, while a radiation dose of 50 Gy in 25 fractions over five weeks increases the chance of tumor sterilization and limits the risk of local recurrence to 5 percent or less," Gerard said.
When asked why an increased dose worked better in rectal cancer patients and not in lung cancer patients, Bradley answered: "Distant metastasis remains the dominant problem with lung cancer, regardless of what dose is given to the tumor."
"I suspect that's the problem," he added.
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