General Session 7: Innovations in Multimodality Management of Rectal Cancer
Daniel T. Chang, MD—Chair, Stanford University
Zhen J. Wang, MD—Chair, University of California San Francisco
Julio Garcia-Aguilar, MD, PhD
Colorectal Service, Department of Surgery, Memorial Sloan-Kettering Cancer Center
Advances in Surgical Management of Patients with Rectal Cancer
Conclusions/Take-Away Points:
• MRI with "rectal protocol" for locoregional staging
• Good surgical technique: TME and APE
• MIS if resources and expertise available
• TAMIS (local excision) for highly selected T1 tumors
• Neoadjuvant therapy and LE an option of T2 tumors
• LPLND for enlarged LPLN (≥7mm) at baseline, particularly if persist (≥4mm) at re-staging MRI
• WW an option for clinical and radiological response after neoadjuvant therapy (best in a clinical trial)
Salma Jabbour, MD
Rutgers Cancer Institute of New Jersey
Radiotherapy for Rectal Cancer—Beyond the German Rectal Trial
Summary: LN Outside the Mesorectum
• Management of lateral LN
- LLND may not be possible in all patients
- Consider optimizing preop therapy with induction chemotherapy or intensification of RT
Take-Horne Points:
• Preoperative CRT
- Short course RT with a delay to surgery also reasonable
- Standard of care for Stage II-III rectal cancer
- Decrease LR and increase sphincter-sparing surgery
• Organ preservation
- CRT followed by local excision in small early stage, distal tumors (T2N0 or <4 cm)
- Watchful waiting in patients in carefully selected patients
• Lateral LN may benefit from LLND, ? RT & induction Chemo
Thomas J. George, MD, FACP
University of Florida Health Cancer Center
Expanding the Role of Chemotherapy for Rectal Cancer
Summary:
• Neoadjuvant chemotherapy represents an emerging opportunity to:
- lmprove delivery of systemic treatment
- Assess in-vivo biologic response to treatment for clinical decision making AND biomarker development
- Selectively consider the option of no RT or no Surgery
- Provide full post-op recovery and/or novel adjuvant treatments
• One size fits all approach CANNOT serve our patient's needs moving forward
Zhen J. Wang, MD
University of California San Francisco
Review of Post-treatment Response