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ASTRO Issues Guideline on Radiation Therapy for Rectal Cancer

Neoadjuvant RT recommended for stage II to III rectal cancer; RT should be performed preoperatively

MONDAY, Oct. 26, 2020 (HealthDay News) — In a clinical practice guideline issued by the American Society for Radiation Oncology, published online Oct. 20 in Practical Radiation Oncology, recommendations are presented for the use of radiotherapy (RT) for rectal cancer.

Jennifer Y. Wo, M.D., from Massachusetts General Hospital in Boston, and colleagues addressed four key questions focused on the use of RT in preoperative management of operable rectal cancer. Recommendations were based on a systematic literature review and were created using a predefined consensus-building methodology.

According to the guideline, for patients with stage II to III rectal cancer, neoadjuvant RT is recommended, with either conventional fractionation with concurrent 5-fluorouracil or capecitabine or short-course RT. RT should be performed before rather than after surgery. In select patients with a lower risk for locoregional recurrence, omission of preoperative RT is conditionally recommended. There was also a conditional recommendation for the addition of chemotherapy before or after chemoradiation or after short-course RT. In select patients, nonoperative management is conditionally recommended if a clinical complete response is achieved after neoadjuvant treatment. Rectum and mesorectal, presacral, internal iliac, and obturator nodes are recommended to be included in the clinical treatment volume. In patients with tumors invading an anterior organ or structure, inclusion of external iliac nodes is conditionally recommended; in patients with tumors involving the anal canal, inclusion of inguinal and external iliac nodes is conditionally recommended.

“This guideline focuses on providing options that can be tailored to patients’ characteristics and their wishes,” Wo said in a statement.

Several authors disclosed financial ties to the biopharmaceutical and medical device industries.

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