Tampere University Hospital (Tays) has become the first hospital in Finland to introduce a new radiotherapy method for rectal cancer. The treatment, called brachytherapy, delivers a high dose of radiation through the rectum directly next to the tumor. The aim is to destroy the tumor while preserving the rectum, allowing more patients to avoid major surgery and a possible permanent stoma.
Approximately 1,500 new cases of rectal cancer are diagnosed in Finland each year. Treatment often involves surgery to remove part or all of the rectum. Although surgery is an effective treatment for cancer, it can result in a permanent stoma and long-term problems with bowel, urinary, and sexual function.
Curing cancer is always the primary goal, but alongside that, we want to maintain the best possible quality of life. If the tumor can be completely removed without removing the rectum, patients may be able to avoid both major surgery and a stoma.
Professor Toni Seppälä of Tampere University and Tays.
Radiation therapy is delivered directly next to the tumor
Tays is the first hospital in Finland to introduce brachytherapy for rectal cancer. The medical term is high-dose-rate brachytherapy, or HDR brachytherapy. During the treatment, radiation is delivered directly to the tumor using a treatment device inserted into the rectum.
The advantage of the method is that a high dose of radiation can be delivered to the tumor while the surrounding healthy tissues are exposed to a lower dose. The treatment uses an iridium-192 radiation source.
The treatment is not suitable for all rectal cancer patients. Each patient’s suitability is assessed by a multidisciplinary team that includes, among others, colorectal surgeons, oncologists, radiation oncologists, and radiologists.
One important patient group is elderly and frail patients, for whom major rectal cancer surgery may be particularly difficult or even too risky. It is estimated that there are more than 100 such patients in Finland each year.
The aim of rectal cancer treatment is increasingly to preserve the organ
In recent years, there has been a significant shift in the way rectal cancer is treated. International studies have shown that some patients achieve a complete response after radiation and chemotherapy. In such cases, close monitoring may be considered instead of surgery.
This treatment strategy is known as organ-sparing therapy or watch-and-wait. Patients are closely monitored so that any tumor recurrence can be detected early and treated with surgery if necessary.
Tumor-targeted brachytherapy aims to increase the number of patients who achieve a complete response to treatment and whose rectum can be safely preserved.
“The goal is not to treat cancer less, but to treat it more precisely. We want to find a treatment that is sufficiently effective for each patient while avoiding treatments and side effects that do not provide additional benefit,” Seppälä says.
Tampere leads national research into organ-sparing treatment
The introduction of the new treatment is part of the NORPPA research program, coordinated by Tampere University and Tays, which is developing new organ-sparing treatments for rectal cancer. The research network includes hospitals from different parts of Finland and Estonia.
The NORPPA-2 study, which is scheduled to start in 2027, will investigate the efficacy of HDR brachytherapy as part of targeted rectal-sparing treatment. The study will examine how effectively local radiotherapy can eradicate tumors and how many patients may be able to avoid major surgery as a result.
At the same time, researchers will investigate whether some patients could be treated without chemotherapy if local radiotherapy proves sufficiently effective against the tumor.
If the research confirms the efficacy and safety of the treatment, the new method could expand the group of rectal cancer patients who can be offered organ-sparing treatment instead of surgery in the future.
