Four in five rectal cancer patients could avoid major surgery, a landmark trial has found.

The breakthrough offers hope of escaping a lifetime with a colostomy bag. Thousands are diagnosed each year.

The STAR-TREC trial tested chemotherapy and radiotherapy as an alternative to surgery. It is one of the largest trials of its kind ever conducted.

The results were published in The Lancet Oncology. The trial was led by the universities of Leeds and Birmingham, working with University College London.

Cancer Research UK helped fund the study, alongside Stand Up to Cancer. The charity called the findings 'life-changing for thousands of people'.

Around 4,100 people are diagnosed with early-stage rectal cancer in England each year. Most are currently offered a major operation called total mesorectal excision.

That surgery removes the entire rectum, plus surrounding fat and lymph nodes. It often leaves patients with a temporary or permanent stoma.

Many also face long-term bowel, bladder or sexual problems. STAR-TREC tested whether this could be avoided.

How the Trial Worked

STAR-TREC recruited more than 500 patients across five countries. They came from England, the Netherlands, Denmark, Belgium and Sweden.

Participants were split into three groups. One had the standard surgery, while two others tried organ-preserving treatment.

One organ-preserving group had five weeks of chemoradiotherapy. The other had a shorter, five-day course of radiotherapy alone.

Surgery only followed if the tumour had not shrunk enough. Where cancer remained, doctors used a smaller, rectum-preserving operation instead of full removal.

Among 163 patients given five weeks of chemoradiotherapy, 93 were cancer-free within 12 months. A further 35 needed only minor surgery.

Just 35 of that group required the full operation. By contrast, the short-course radiotherapy group fared worse.

Of 168 patients given short-course radiotherapy, only 53 were cancer-free without more treatment. Sixty-six went on to need radical surgery.

Chemoradiotherapy was clearly the stronger option. Researchers say it points to a preferred future treatment.

Professor Simon Bach, a colorectal surgeon at UCL, led the trial. He said patients had long been told losing their rectum was 'the price of curing their cancer'.

'These results suggest that for many people, that price no longer has to be paid,' he said. He added that the next step was confirming the results hold over time.

Professor David Sebag-Montefiore, of Leeds University, also worked on the trial. He said it showed a 'smarter, kinder' radiotherapy approach could spare major surgery.

Patients also had relatively few severe short-term side effects, he added. That was seen as an encouraging sign.

A Patient's Story

Hugh Chown, 65, from Harrogate, joined the trial in January 2021. He had just been diagnosed with rectal cancer at Leeds Teaching Hospitals NHS Trust.

His wife, Janet, died aged 41 in 2001 from bowel cancer. That made his own diagnosis especially hard to process.

'The diagnosis was totally unexpected. I was shocked but accepting of it. I knew worrying wouldn't help, so I just focused on living life,' he said.

His consultant told him about STAR-TREC two weeks later. She warned that standard treatment would likely leave him with a permanent colostomy bag.

Hugh underwent five weeks of chemoradiotherapy. He took tablets twice a day, alongside daily radiotherapy sessions.

He described feeling fatigued, but said it was 'minimal' compared with the alternative. Three months later, his cancer had disappeared entirely.

He remains cancer-free today. Researchers will follow patients for three years to check the cancer does not return.

Updated results are expected in 2027. Michelle Mitchell, of Cancer Research UK, said bowel screening meant more cancers were caught early, but treatment 'hasn't made it any easier' for many patients.

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