Some Patients With Locally Advanced Rectal Cancer May Avoid Surgery

Steven Nurkin, MD, assistant professor of surgical oncology at Roswell Park Cancer Institute in Buffalo, New York, said this presentation highlights the fact that there is no one-size-fits-all in this patient population.

“I think this presentation does a wonderful job at explaining how we are all over the place in the management of rectal cancer. We have induction chemotherapy versus consolidation chemotherapy in the neoadjuvant setting,” Dr Nurkin told Cancer Therapy Advisor. “And then there is aggressive total mesorectal excision (radical surgery) versus eliminating surgery all together with non-operative management, in the setting of complete clinical responses.”

Dr Garcia-Aguilar said one of the biggest challenges today for oncologists is identifying treatment approaches that maintain or even improve oncologic outcomes but still preserve quality of life for patients.

He and his colleagues have identified different tumor characteristics that are associated with recurrence and probability of survival in patients with locally advanced rectal cancer. Dr Garcia-Aguilar said that the risk stratification is based on baseline clinical staging and tumor response to chemoradiotherapy.

Using this risk stratification approach has lead his team to question whether all patients with locally advanced rectal cancer require every component of the multimodal regimen. Evidence supports the notion that select patients may be spared 1 or more treatment modalities without compromising long-term oncologic outcomes.

Currently, multimodality therapy provides excellent local tumor control and long-term survival for patients with locally advanced rectal cancer, according to Dr Garcia-Aguilar. It should, however, always be a priority for oncologists to discuss clinical trial participation.

“There is probably more than 1 way to treat patients with locally advanced rectal cancer. These patients require guidance from an experienced multidisciplinary team, and treatment can often be tailored to the individual, their goals of care and the tumor’s biology,” concluded Dr Nurkin.

Reference

1. Garcia-Aguilar J, Glynne-Jones R, Schrag D. Multimodal rectal cancer treatment: in some cases, less may be more. Am Soc Clin Oncol Educ Book. 2016;35:92-102.