Bashar Safar, chief of colorectal surgery, describes one of the latest approaches against advanced stage rectal cancer: the 5x5 protocol. As an aggressive form of rectal cancer treatment, the 5x5 protocol delivers 5 grays (Gy) of radiation to patients for five days for a total of 25 Gy.
The five x 5 Protocol entails giving radiation over a five day period in combination with full dose chemotherapy shortly after the radiation is ended. This allows the patient to get uh much more effective chemotherapy before surgery. And uh it's quite a bit different to the traditional way of giving radiation, which is a five week radiation. We typically give uh two months of chemotherapy and then a month after that we restaged the patient. What we have found In our experience over the last two years is the tumors have responded a lot better. Some have actually completely disappeared and up to probably 30%. And we're in the process of reviewing our results and uh both uh present them and publish them nationally. So there are multiple advantages. Uh First of all, the radiation itself is abbreviated over five days, so it's not as hard on the patient to actually fit it into their schedule. After that they take a break of two weeks and then they get chemotherapy and it's sort of full dose chemotherapy that can be hard on the patients. But what we have actually found an experience that most patients tolerated well. Um So that goes on for two more months. The benefit is in patients. For example if they had a little bit more of an advanced tumour were actually able to deliver real time a real dose chemotherapy as opposed to the chemotherapy that delivered with a traditional five weeks. The five weeks has usually been given with one drug which is a radio sensitize er It's called five F. You or capeside of in the advantages the uh you can't really usually combine full dose chemotherapy with radiation is felt to be too toxic to the patient. So that's one advantage of the five by five, as I mentioned earlier. Also we feel that we've had better responses by giving chemotherapy up front as well as radiation than the traditional five weeks. So that's another advantage. And lastly, there is this concept of sort of giving as much chemotherapy before surgery or upfront because of patients go to surgery under, there are complications and they might not be able to get chemotherapy after. So then you're delivering effective therapy before uh surgery. We've had many success stories with the 5x5 and I'll share with you a few. There have been patients who have been given this therapy or this regiment who have completely responded to our treatment and we have decided to watch full to watch, watch them and not do surgery on them. Now, this is not a well proven way of treating this disease. However, they the tumor completely disappears and there is just a scar. Uh, the other advantages or other patients have had complete shrinkage of their tumors and allowed a very difficult surgery to be done a little bit easier. And lastly, patients with Stage four disease if they had, if they have metastases to other organs, it again allows us to give systemic therapy ahead of time and address both liver and or rectum at the same time when it does come time to surgery, we've had Up to 30 or 40 patients that were treated in this protocol. And really, we have not had to. Any of these patients have a uh an adverse events or any bad outcomes from this from this therapy. I can't really make a comment whether we have better cure or not, but I do believe that delivering the chemotherapy upfront um gives us the advantage of uh, of curing if there is a small metastases outside, but there is no really substantiated, you know, um, research or anything to back up this claim. There's really been no studies to look at functional outcomes after surgery from this method versus the traditional method. So to say that this is uh completely better, I think. It's not necessarily true, but it's very much convenient if you like for the patient to receive this therapy. Uh the way it's structured in the way that we deliver it because it doesn't take away too much time. So if somebody is working, they take a week off from the radiation and then they go back to work and then the chemo is delivered once every two weeks for a period of two months. And usually for a day or two you're tired and then you get back to work. So they're far less interruptions to the patient's quality of life with a very strong potential improvement and outcome post op or eventually sort of long term. Yeah. Yeah.
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