A Wibe1, W L Law, V Fazio, C P Delaney. 1. Department of Cancer Research and Molecular Medicine, Norwegian University of Science and Technology, Trondheim, Norway; Department of Surgery, St Olavs Hospital, Trondheim University Hospital, Trondheim, Norway.
Abstract
AIM: To report data supporting the development of tailored treatment strategies for rectal cancer. METHOD: A comprehensive review of the literature on the impact of prognostic factors cur-rently not included in international guidelines in rectal cancer management. RESULTS: There is considerable variation in treatment guidelines for rectal cancer worldwide, especially for Stage II and Stage III disease. Long-term side effects of chemoradiotherapy are not considered in any guideline. Detailed knowledge, and the prognostic impact, of the circumferential resection margin, tumour grade and venous invasion should be factored into the development of a treatment strategy. CONCLUSION: Factors additional to the TNM system should improve decision making for contemporary rectal cancer treatment. Optimized radiological and pathological evaluations, and a focus on detailed clinical factors, should be the basis for treatment decisions. International guidelines should consider all known prognostic factors for long-term oncological and functional outcomes. Colorectal Disease
AIM: To report data supporting the development of tailored treatment strategies for rectal cancer. METHOD: A comprehensive review of the literature on the impact of prognostic factors cur-rently not included in international guidelines in rectal cancer management. RESULTS: There is considerable variation in treatment guidelines for rectal cancer worldwide, especially for Stage II and Stage III disease. Long-term side effects of chemoradiotherapy are not considered in any guideline. Detailed knowledge, and the prognostic impact, of the circumferential resection margin, tumour grade and venous invasion should be factored into the development of a treatment strategy. CONCLUSION: Factors additional to the TNM system should improve decision making for contemporary rectal cancer treatment. Optimized radiological and pathological evaluations, and a focus on detailed clinical factors, should be the basis for treatment decisions. International guidelines should consider all known prognostic factors for long-term oncological and functional outcomes. Colorectal Disease
Authors: Dean A Harris; Kymberley Thorne; Hayley Hutchings; Saiful Islam; Gail Holland; Olivia Hatcher; Sarah Gwynne; Ian Jenkins; Peter Coyne; Michael Duff; Melanie Feldman; Des C Winter; Simon Gollins; Phil Quirke; Nick West; Gina Brown; Deborah Fitzsimmons; Alan Brown; John Beynon Journal: BMJ Open Date: 2016-11-21 Impact factor: 2.692