Radiation Therapy for Rectal Cancer: Executive Summary of an ASTRO Clinical Practice Guideline.

Autor:	Wo JY; Department of Radiation Oncology, Massachusetts General Hospital, Boston, Massachusetts., Anker CJ; Division of Radiation Oncology, University of Vermont Cancer Center, Burlington, Vermont., Ashman JB; Department of Radiation Oncology, Mayo Clinic, Phoenix, Arizona., Bhadkamkar NA; Department of General Oncology, MD Anderson Cancer Center, Houston, Texas., Bradfield L; American Society for Radiation Oncology, Arlington, Virginia., Chang DT; Department of Radiation Oncology, Stanford University, Stanford, California., Dorth J; Department of Radiation Oncology, Seidman Cancer Center, University Hospitals, Cleveland, Ohio., Garcia-Aguilar J; Department of Colorectal Surgery, Memorial Sloan Kettering Cancer Center, New York, New York., Goff D; Patient Representative, Las Cruces, New Mexico., Jacqmin D; Department of Human Oncology, University of Wisconsin, Madison, Wisconsin., Kelly P; Department of Radiation Oncology, Orlando Health, Orlando, Florida., Newman NB; Department of Radiation Oncology, Vanderbilt University Medical Center, Nashville, Tennessee., Olsen J; Department of Radiation Oncology, University of Colorado, Aurora, Colorado., Raldow AC; Department of Radiation Oncology, University of California, Los Angeles, California., Ruiz-Garcia E; Department of Medical Oncology, Instituto Nacional de Cancerologia, Mexico City, Mexico., Stitzenberg KB; Department of Surgery, University of North Carolina, Chapel Hill, North Carolina., Thomas CR Jr; Department of Radiation Oncology, Oregon Health & Science University, Portland, Oregon., Wu QJ; Department of Radiation Oncology, Duke University, Durham, North Carolina., Das P; Department of Radiation Oncology, MD Anderson Cancer Center, Houston, Texas. Electronic address: prajdas@mdanderson.org.
Jazyk:	angličtina
Zdroj:	Practical radiation oncology [Pract Radiat Oncol] 2021 Jan-Feb; Vol. 11 (1), pp. 13-25. Date of Electronic Publication: 2020 Oct 21.
DOI:	10.1016/j.prro.2020.08.004
Abstrakt:	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. (Copyright © 2020 American Society for Radiation Oncology. Published by Elsevier Inc. All rights reserved.)
Databáze:	MEDLINE
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