Changes in clinical guidelines for the treatment of colorectal cancer in 2024

Abstract

Aim. The ensuring that changes to clinical guidelines can be discussed more widely before they are formally introduced into clinical practice.Materials and methods. A brief review of the literature and rationale for each proposed major change in the treatment section is presented. The refusal to carry out preoperative radiation therapy for cancer of the upper ampullary rectum, the narrowing of indications for preoperative radiation therapy for cancer of the mid-ampullary rectum, as well as the expansion of indications for total non-adjuvant chemotherapy for rectal cancer with damage to the circular resection margin are discussed. Changes to the drug treatment section are discussed.Results. This article presents planned changes to clinical guidelines for the treatment of non-metastatic colorectal cancer in 2024. The most significant alterations concerned neoadjuvant treatment of rectal cancer and adjuvant treatment of colon cancer. A new algorithm was proposed for choosing rectal cancer neoadjuvant therapy, considering individual treatment decisions.Conclusion. A consensus was achieved concerning the necessity to expand indications for neoadjuvant rectal cancer chemotherapy, but only in patients with good functional status. The most benefit can be achieved in patients, for whom complete clinical response is the aim of the treatment and in patients with positive circumferential resection margin.