Clinical practice guideline updated for radiation therapy for rectal cancer

In a clinical practice guideline issued by the American Society for Radiation Oncology and published online Nov. 25 in Practical Radiation Oncology, updated recommendations are presented for the use of radiation therapy (RT) for operable rectal cancer.

Jennifer Y. Wo, M.D., from Massachusetts General Hospital in Boston, and colleagues provide an update on three key questions related to the role of RT for patients with operable rectal cancer: neoadjuvant RT indications, neoadjuvant regimen selection, and indications for consideration of a nonoperative management (NOM) or local excision approach after definitive/preoperative chemoradiation.

According to the authors, neoadjuvant RT is strongly recommended for patients with stage II to III rectal cancer, but consideration of omission of neoadjuvant RT is conditionally recommended in favor of neoadjuvant chemotherapy with a favorable treatment response or upfront surgery among patients deemed at lower risk for locoregional recurrence.

A total neoadjuvant therapy (TNT) approach is strongly recommended for patients with T3 to T4 and node-positive rectal cancer undergoing neoadjuvant RT. TNT with chemotherapy before or after long-course chemoradiation is strongly recommended among patients with a higher risk for locoregional recurrence, while there is a conditional recommendation for TNT with short-course RT followed by chemotherapy.

Concurrent chemoradiation followed by consolidation chemotherapy is strongly recommended for patients with rectal cancer for whom NOM is a priority. Selection of RT dose-fractionation regimen, therapy sequence, and consideration of NOM should be ascertained by multidisciplinary consensus.

“These emerging treatment paradigms allow for more personalized and nuanced recommendations that are tailored to each individual patient’s level of risk as well as their priorities, providing the right balance between effective cancer control and preserving quality of life,” Wo said in a statement.

Several authors disclosed ties to the biopharmaceutical industry.

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