Julio Garcia-Aguilar is a surgeon in search of ways to cure some rectal cancer patients without using surgery.
Over many decades, City of Hope colorectal surgeon Julio Garcia-Aguilar, M.D., Ph.D., has seen cancer patients live longer — and better. And he’s doing his own part to keep the progress going.
His strategy might seem surprising for a surgeon, though. Garcia-Aguilar’s promising research is showing that some rectal cancer patients can be treated successfully without having an operation.
“We can cure many patients with surgery. But when you remove the rectum, the consequences for the patient are very significant. If we can, we want to avoid those consequences,” said Garcia-Aguilar, chair of the Department of Surgery and co-director of the Gastrointestinal Oncology Program.
The idea started years ago.
Surgery was once was the main treatment for rectal cancer. Over time, physicians also started giving patients radiation and chemotherapy to shrink the tumors before surgery. Not only did that boost success, but surgeons also noticed something else exciting.
In some cases, doctors could find no cancer in tissue removed during surgery. Chemo and radiation eliminated the cancer.
“You ask yourself, ‘Well, why are we performing surgery?’” he said. “You wonder whether some patients might not need surgery. This theme applies to other tumors: It has happened already with breast cancer and anal cancer.”
Armed with persistence and a commitment to helping his patients live better, Garcia-Aguilar leads a large, national study of a new strategy. Typically, patients receive chemotherapy and radiation before surgery, with another round of chemo after their procedure. Garcia-Aguilar and his colleagues study what happens when those extra weeks of chemo are shifted before surgery instead of afterward.
Early results show no remaining disease before surgery in almost a third of patients with stage 2 and 3 rectal cancer.
But he preaches caution, too. “How do we know there’s no cancer without removing the organ? And how do we predict which patient’s tumor will respond to therapy?” he asked.
He and his colleagues now are searching for clues in the body that can tip doctors off about whether a patient could successfully avoid surgery.
Garcia-Aguilar aims to take his scientific curiosity and compassion to the forefront of the next great shift in how doctors treat rectal cancer. “You cannot build your career thinking that you’re going to be doing 15 years from now the same thing you are doing now,” he said. “That is the only thing we can be certain of, that things will change.”
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