Jennifer Y Wo1, Christopher J Anker2, Jonathan B Ashman3, Nishin A Bhadkamkar4, Lisa Bradfield5, Daniel T Chang6, Jennifer Dorth7, Julio Garcia-Aguilar8, David Goff9, Dustin Jacqmin10, Patrick Kelly11, Neil B Newman12, Jeffrey Olsen13, Ann C Raldow14, Erika Ruiz-Garcia15, Karyn B Stitzenberg16, Charles R Thomas17, Q Jackie Wu18, Prajnan Das19. 1. Department of Radiation Oncology, Massachusetts General Hospital, Boston, Massachusetts. 2. Division of Radiation Oncology, University of Vermont Cancer Center, Burlington, Vermont. 3. Department of Radiation Oncology, Mayo Clinic, Phoenix, Arizona. 4. Department of General Oncology, MD Anderson Cancer Center, Houston, Texas. 5. American Society for Radiation Oncology, Arlington, Virginia. 6. Department of Radiation Oncology, Stanford University, Stanford, California. 7. Department of Radiation Oncology, Seidman Cancer Center, University Hospitals, Cleveland, Ohio. 8. Department of Colorectal Surgery, Memorial Sloan Kettering Cancer Center, New York, New York. 9. Patient Representative, Las Cruces, New Mexico. 10. Department of Human Oncology, University of Wisconsin, Madison, Wisconsin. 11. Department of Radiation Oncology, Orlando Health, Orlando, Florida. 12. Department of Radiation Oncology, Vanderbilt University Medical Center, Nashville, Tennessee. 13. Department of Radiation Oncology, University of Colorado, Aurora, Colorado. 14. Department of Radiation Oncology, University of California, Los Angeles, California. 15. Department of Medical Oncology, Instituto Nacional de Cancerologia, Mexico City, Mexico. 16. Department of Surgery, University of North Carolina, Chapel Hill, North Carolina. 17. Department of Radiation Oncology, Oregon Health & Science University, Portland, Oregon. 18. Department of Radiation Oncology, Duke University, Durham, North Carolina. 19. Department of Radiation Oncology, MD Anderson Cancer Center, Houston, Texas. Electronic address: prajdas@mdanderson.org.
Abstract
PURPOSE: This guideline reviews the evidence and provides recommendations for the indications and appropriate technique and dose of neoadjuvant radiation therapy (RT) in the treatment of localized rectal cancer. METHODS: The American Society for Radiation Oncology convened a task force to address 4 key questions focused on the use of RT in preoperative management of operable rectal cancer. These questions included the indications for neoadjuvant RT, identification of appropriate neoadjuvant regimens, indications for consideration of a nonoperative or local excision approach after chemoradiation, and appropriate treatment volumes and techniques. Recommendations were based on a systematic literature review and created using a predefined consensus-building methodology and system for grading evidence quality and recommendation strength. RESULTS: Neoadjuvant RT is recommended for patients with stage II-III rectal cancer, with either conventional fractionation with concurrent 5-FU or capecitabine or short-course RT. RT should be performed preoperatively rather than postoperatively. Omission of preoperative RT is conditionally recommended in selected patients with lower risk of locoregional recurrence. Addition of chemotherapy before or after chemoradiation or after short-course RT is conditionally recommended. Nonoperative management is conditionally recommended if a clinical complete response is achieved after neoadjuvant treatment in selected patients. Inclusion of the rectum and mesorectal, presacral, internal iliac, and obturator nodes in the clinical treatment volume is recommended. In addition, inclusion of external iliac nodes is conditionally recommended in patients with tumors invading an anterior organ or structure, and inclusion of inguinal and external iliac nodes is conditionally recommended in patients with tumors involving the anal canal. CONCLUSIONS: Based on currently published data, the American Society for Radiation Oncology task force has proposed evidence-based recommendations regarding the use of RT for rectal cancer. Future studies will look to further personalize treatment recommendations to optimize treatment outcomes and quality of life.
PURPOSE: This guideline reviews the evidence and provides recommendations for the indications and appropriate technique and dose of neoadjuvant radiation therapy (RT) in the treatment of localized rectal cancer. METHODS: The American Society for Radiation Oncology convened a task force to address 4 key questions focused on the use of RT in preoperative management of operable rectal cancer. These questions included the indications for neoadjuvant RT, identification of appropriate neoadjuvant regimens, indications for consideration of a nonoperative or local excision approach after chemoradiation, and appropriate treatment volumes and techniques. Recommendations were based on a systematic literature review and created using a predefined consensus-building methodology and system for grading evidence quality and recommendation strength. RESULTS: Neoadjuvant RT is recommended for patients with stage II-III rectal cancer, with either conventional fractionation with concurrent 5-FU or capecitabine or short-course RT. RT should be performed preoperatively rather than postoperatively. Omission of preoperative RT is conditionally recommended in selected patients with lower risk of locoregional recurrence. Addition of chemotherapy before or after chemoradiation or after short-course RT is conditionally recommended. Nonoperative management is conditionally recommended if a clinical complete response is achieved after neoadjuvant treatment in selected patients. Inclusion of the rectum and mesorectal, presacral, internal iliac, and obturator nodes in the clinical treatment volume is recommended. In addition, inclusion of external iliac nodes is conditionally recommended in patients with tumors invading an anterior organ or structure, and inclusion of inguinal and external iliac nodes is conditionally recommended in patients with tumors involving the anal canal. CONCLUSIONS: Based on currently published data, the American Society for Radiation Oncology task force has proposed evidence-based recommendations regarding the use of RT for rectal cancer. Future studies will look to further personalize treatment recommendations to optimize treatment outcomes and quality of life.
Authors: Kai Huang; Prajnan Das; Adenike M Olanrewaju; Carlos Cardenas; David Fuentes; Lifei Zhang; Donald Hancock; Hannah Simonds; Dong Joo Rhee; Sam Beddar; Tina M Briere; Laurence Court Journal: J Appl Clin Med Phys Date: 2022-07-08 Impact factor: 2.243
Authors: Emmanouil Fokas; Ane Appelt; Alexandra Gilbert; David Sebag-Montefiore; Claus Rödel; Robert Glynne-Jones; Geerard Beets; Rodrigo Perez; Julio Garcia-Aguilar; Eric Rullier; J Joshua Smith; Corrie Marijnen; Femke P Peters; Maxine van der Valk; Regina Beets-Tan; Arthur S Myint; Jean-Pierre Gerard; Simon P Bach; Michael Ghadimi; Ralf D Hofheinz; Krzysztof Bujko; Cihan Gani; Karin Haustermans; Bruce D Minsky; Ethan Ludmir; Nicholas P West; Maria A Gambacorta; Vincenzo Valentini; Marc Buyse; Andrew G Renehan Journal: Nat Rev Clin Oncol Date: 2021-08-04 Impact factor: 66.675
Authors: Re-I Chin; Ebunoluwa E Otegbeye; Kylie H Kang; Su-Hsin Chang; Scott McHenry; Amit Roy; William C Chapman; Lauren E Henke; Shahed N Badiyan; Katrina Pedersen; Benjamin R Tan; Sean C Glasgow; Matthew G Mutch; Pamela P Samson; Hyun Kim Journal: JAMA Netw Open Date: 2022-02-01