Radiation Therapy for Rectal Cancer: An ASTRO Clinical Practice Guideline Focused Update.

Autor:	Wo JY; Department of Radiation Oncology, Massachusetts General Hospital, Boston, Massachusetts. Electronic address: JWO@mgh.harvard.edu., Ashman JB; Department of Radiation Oncology, Mayo Clinic, Phoenix, Arizona., Bhadkamkar NA; Department of General Oncology, University of Texas MD Anderson Cancer Center, Houston, Texas., Bradfield L; American Society for Radiation Oncology, Arlington, Virginia., Chang DT; Department of Radiation Oncology, University of Michigan, Ann Arbor, Michigan., Hanna N; Department of Surgery, Thomas Jefferson University, Philadelphia, Pennsylvania., Hawkins M; Department of Medical Physics and Biomedical Engineering, University of College London, London, England., Holtz M; Patient Representative, Oak Ridge Associated Universities, Knoxville, Tennessee., Kim E; Department of Radiation Oncology, University of Washington, Seattle, Washington., Kelly P; Department of Radiation Oncology, Orlando Health, Orlando, Florida., Ling DC; Department of Radiation Oncology, University of Southern California, Los Angeles, California., Olsen JR; Department of Radiation Oncology, University of Colorado, Aurora, Colorado., Palta M; Department of Radiation Oncology, Duke Cancer Institute, Durham, North Carolina., Raldow AC; Department of Radiation Oncology, University of Southern California, Los Angeles, California., Ruiz-Garcia E; Department of Medical Oncology, Instituto Nacional de Cancerologia, Mexico City, Mexico., Sheybani A; Department of Radiation Oncology, UnityPoint Health, Des Moines, Iowa., Stitzenberg KB; Department of Surgery, University of North Carolina, Chapel Hill, North Carolina., Das P; Department of Gastrointestinal Radiation Oncology, University of Texas MD Anderson Cancer Center, Houston, Texas.
Jazyk:	angličtina
Zdroj:	Practical radiation oncology [Pract Radiat Oncol] 2024 Nov 16. Date of Electronic Publication: 2024 Nov 16.
DOI:	10.1016/j.prro.2024.11.003
Abstrakt:	Purpose: With the results of several recently published clinical trials, this guideline focused update provides evidence-based recommendations for the indications and dose-fractionation regimens for neoadjuvant radiation therapy (RT), optimal sequencing of RT and systemic therapy in the context of total neoadjuvant therapy (TNT), and considerations for selective omission of RT and surgery for rectal cancer. Methods: The American Society for Radiation Oncology convened a multidisciplinary task force to update 3 key questions that focused on the role of RT for patients with operable rectal cancer. The key questions addressed (1) indications for neoadjuvant RT, (2) selection of neoadjuvant regimens, and (3) indications for consideration of a nonoperative management (NOM) or local excision approach after definitive/preoperative chemoradiation. Recommendations were based on a systematic literature review and created using a predefined consensus-building methodology and system for quality of evidence grading and strength of recommendation. Results: For patients with stage II-III rectal cancer, neoadjuvant RT was strongly recommended; however, among patients deemed at lower risk of locoregional recurrence, consideration of omission of neoadjuvant RT was conditionally recommended in favor of neoadjuvant chemotherapy with a favorable treatment response or upfront surgery. For patients with T3-T4 and node positive rectal cancer undergoing neoadjuvant RT, a TNT approach was strongly recommended. Among patients with higher risk of locoregional recurrence, TNT with chemotherapy before or after long-course chemoradiation was strongly recommended, whereas TNT with short-course RT followed by chemotherapy was conditionally recommended. For patients with rectal cancer for whom NOM is a priority, concurrent chemoradiation followed by consolidation chemotherapy was strongly recommended. Selection of RT dose-fractionation regimen, sequencing of therapies, and consideration of NOM should be determined by multidisciplinary consensus, and based on disease extent, disease location, patient preferences, and quality of life considerations. Conclusions: The task force has proposed recommendations to inform best clinical practices on the use of RT for rectal cancer with strong emphasis on multidisciplinary care. Future studies should focus on further addressing optimal treatment regimens to allow for more personalized recommendations based on individual risk stratification and patient priorities regarding quality of life. (Copyright © 2024 American Society for Radiation Oncology. Published by Elsevier Inc. All rights reserved.)
Databáze:	MEDLINE
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