Highlights
- •Among academic radiation oncologists, medical oncologists, and colorectal surgeons, the traditional regimen of long-course chemoradiation, surgery, and adjuvant chemotherapy is now infrequently recommended for locally advanced rectal cancer.
- •Total neoadjuvant therapy has been widely adopted for locally advanced node positive rectal tumors with variable patterns of care with respect to sequencing of chemotherapy and radiotherapy.
- •Fractionation with long-course chemoradiation remains the majority; however, short-course radiotherapy is gaining acceptance, notably for mid- and upper rectal tumors.
- •Non-operative management after a clinical complete response in low rectal tumors has gained traction, transforming locally advanced rectal cancer from a once classically perceived surgical disease.
Abstract
Purpose
To assess the current treatment patterns in locally advanced rectal cancer (LARC)
among radiation oncologists (RO), medical oncologists (MO), and colorectal surgeons
(SR) specializing in gastrointestinal (GI) malignancies at academic institutions.
Materials and Methods
An online survey consisting of 7 LARC clinical vignettes was distributed to GI specialists
practicing at ACGME accredited academic institutions. Treatment paradigms consisted
of long-course chemoradiation (LC-CRT) and short-course (SCRT) radiotherapy, chemotherapy
(CHT), and surgery. The survey was open from January to April 2021.
Results
Thirty-six RO, 14 MO and 21 SR (71/508 physicians) replied resulting in a response
rate of 14.0%. For low rectal node positive tumors, 88.7% of primary recommendations
incorporated TNT (73.1% LC-CRT, 26.9% SCRT). NOM was preferred by 41.3% if a clinical
complete response (cCR) was achieved. The presence of high-risk features led 95.8%
of physicians to employ TNT (79.4% LC-CRT, 20.6% SCRT). For a cT3N1-2 mid-rectal tumor
without high-risk features, 85.9% would primarily recommend TNT (56.6% LC-CRT, 43.4%
SCRT). For a cT4bN2a mid-rectal tumor without high-risk features, 97.2% of primary
recommendations included TNT (76.9% LC-CRT, 23.1% SCRT).
Conclusion
Among academic RO, MO, and SR, the traditional regimen of LC-CRT, surgery, and adjuvant
CHT is now infrequently recommended for LARC. TNT has been widely adopted for locally
advanced node positive rectal tumors with variable patterns of care with respect to
sequencing of CHT and RT. Fractionation with LC-CRT remained the majority. Non-operative
management after a cCR in low rectal tumors has gained traction transforming LARC
from a once classically perceived surgical disease.
Keywords
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Article info
Publication history
Published online: September 16, 2022
Accepted:
June 7,
2022
Received in revised form:
March 18,
2022
Received:
February 8,
2022
Identification
Copyright
© 2022 Elsevier Inc. All rights reserved.
