5×5 Rectal Cancer Treatment Protocol | Q&A


(relaxing music)>>The 5×5 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 a much more effective
chemotherapy before surgery and is quite a bit different to the traditional way of giving radiation, which is a five week radiation. We typically give two
months of chemotherapy, and then a month after that, we restage 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, up to probably 30%. And we’re in the process
of reviewing our results and both present them and
publish them nationally. (relaxing music)>>So there are multiple advantages. 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 patient, but what we have actually
found and experienced is that most patients tolerate it well. 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 tumor, we were actually able
to deliver real-time, 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 radiosensitizer, it’s called 5-FU or capecitabine, the advantages, you can’t really usually
combine full-dose chemotherapy with radiation, it’s felt to
be too toxic to the patient. So that’s one advantage of the 5×5. As I mentioned earlier, also we feel that we’ve
had better responses by giving chemotherapy
upfront 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 if patients go to surgery and there are complications then they might not be able
to get chemotherapy after. So then you’re delivering
effective therapy before surgery. (relaxing music) We’ve had many success
stories with the 5×5, and I’ll share with you a few. There have been patients who’ve been given this therapy or this regimen, who’ve completely
responded to our treatment, and we have decided to watch them, and not do surgery on them. Now this is not a well-proven
way of treating this disease. However, the tumor completely disappears and there is just a scar. The other advantages our
other patients have had complete shrinkage of their tumor and allowed a very
difficult surgery to be done a little bit easier. Lastly, patients with stage four disease, if they have metastasize 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 down to surgery. We’ve had up to 30 or 40
patients that we’ve treated in this protocol, and really we’ve not had
any of these patients have an adverse event or any
bad outcomes from this therapy. (relaxing music) I can’t really make a comment whether we have better cure or not, but I do believe that delivering
the chemotherapy upfront gives us the advantage of curing if there’s small metastasizes outside, but there is no really
substantiated research or anything to backup this claim. There is really been no studies to look at functional outcomes after
surgery from this method versus the traditional method, so to say that this is completely better, I think it’s not necessarily true, but it’s very much convenient to feel like for the patient to receive this therapy the way it’s structured, and the way that we deliver it because it doesn’t take
away too much time. So if somebody’s working, they take a week off from the radiation, and then they go back to work, and then the chemo’s
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 there are far less interruptions to the patient’s quality of life with a very strong potential
improvement in outcome post-op or eventually sort of longterm. (relaxing music)

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