More than 14,500 new patients in the UK are diagnosed each year with cancer of the rectum (the lowest 15cm of the bowel), THAT IS 27% OF ALL NEWLY DIAGNOSED BOWEL CANCERS EACH YEAR. For these patients, incomplete surgical removal of the tumour can result in local tumour recurrence a reduced chance of survival.
Traditionally, post-operative treatment such as chemo-radiotherapy has been given to patients following excision of advanced tumours but tumour recurrence rates in this group of patients remain high, despite advances in optimal surgical techniques (Total Mesorectal Excision surgery, pioneered by Professor Bill Heald in Basingstoke).
The Wessex Cancer Trust and Siemens Medical UK helped us to fund The MERCURY Study – a prospective, European, multidisciplinary project that demonstrated the accuracy and feasibility of MRI (Magnetic Resonance Imaging) as a method of assessing rectal cancer.
This means that using specialised MRI scanning techniques, the features of a rectal tumour can be identified pre-operatively, therefore allowing individualised, optimal treatment to be planned by the multidisciplinary team. Pre-operative therapies can be given to shrink advanced tumours prior to surgery and, early tumours can be identified for which surgery alone is best and pre-operative therapy is not necessary.
The successful results of MERCURY have been presented at medical meetings internationally and published in the BMJ. The MERCURY Study is also cited in the current research evidence for ‘Improving Outcomes in Colorectal Cancer’ from The National Institute of Clinical Excellence.
The MERCURY Study was successful in achieving its aim – to show that pre-operative MRI was equivalent to the corresponding post-operative pathology result and, can therefore be used by the multidisciplinary team for pre-operative treatment planning. It also provided a comprehensive database for the analysis of many other aspects of the management and treatment of patients with rectal cancer.
Patients from MERCURY have been followed up to assess disease recurrence and survival. The results of this follow up have been published in the Journal of Clinical Oncology. Results from this study showed that MRI assessment is superior to other methods in the assessment of overall survival and the local recurrence of the cancer. Another issue that has been highlighted from this database is that patients with low rectal tumours (tumours in the last 6cm of rectum) have a higher risk of incomplete surgical excisions, meaning that the tumour is not completely removed.
The Study Group are now undertaking MERCURY 2 (Low Rectal Cancer Study), using MRI-based, multidisciplinary team management. The primary aim of this study is to reduce the rate of surgery that does not completely remove the tumour in these patients from 30% to less than 10%. This will improve overall survival for patients.
The MERCURY Study Group is a collaboration of specialist colorectal multidisciplinary teams from 12 hospitals in the UK, Sweden, Germany and Norway. Each team consists of surgeons, radiologists, oncologists, pathologists and nurses. Members of the Study Group have attended specialised workshops to ensure high quality, standardised assessment and data reporting for MERCURY research.
These concepts represent a blueprint for the future development of all aspects of management for this – potentially the most curable of all the common cancers.