Clinical practice guidelines for the surgical treatment of rectal cancer: a consensus statement of the Hellenic Society of Medical Oncologists (HeSMO)

Abstract

In rectal cancer management, accurate staging by magnetic resonance imaging, neo-adjuvant treatment with the use of radiotherapy, and total mesorectal excision have resulted in remarkable improvement in the oncological outcomes. However, there is substantial discrepancy in the therapeutic approach and failure to adhere to international guidelines among different Greek-Cypriot hospitals. The present guidelines aim to aid the multidisciplinary management of rectal cancer, considering both the local special characteristics of our healthcare system and the international relevant agreements (ESMO, EURECCA). Following background discussion and online communication sessions for feedback among the members of an executive team, a consensus rectal cancer management was obtained. Statements were subjected to the Delphi methodology voting system on two rounds to achieve further consensus by invited multidisciplinary international experts on colorectal cancer. Statements were considered of high, moderate or low consensus if they were voted by ≥80%, 60-80%, or <60%, respectively; those obtaining a low consensus level after both voting rounds were rejected. One hundred and two statements were developed and voted by 100 experts. The mean rate of abstention per statement was 12.5% (range: 2-45%). In the end of the process, all statements achieved a high consensus. Guidelines and algorithms of diagnosis and treatment were proposed. The importance of centralization, care by a multidisciplinary team, adherence to guidelines, and personalization is emphasized.

Novel Prognostic Biomarkers in Metastatic and Locally Advanced Colorectal Cancer: Micronuclei Frequency and Telomerase Activity in Peripheral Blood Lymphocytes

“…They share two components, folinic acid (FA) and 5-fluorouracil (5-FU), while oxaliplatin and irinotecan are the compounds that differentiate the first two respectively or if combined make the later. CAPOX on the other hand, which along with FOLFOX is primarily used to treat laCRC (21), contains capecitabine and oxaliplatin. Based on bibliographic evidence validating the effect of these agents upon MNf and TA, it is evident that there is no universal effect.…”

“…From December 2016 to February 2021, 94 consecutive patients treated at the Department of Medical Oncology, University Hospital of Heraklion were evaluated for participation in this study. Inclusion criteria were: I) Patients with radiologic evidence of mCRC documented by computed tomography (CT) and/or magnetic resonance imaging (MRI) presenting measurable disease treated with first line systemic treatment according to the Hellenic Society of Medical Oncologists (HeSMO) guidelines (20), II) Patients with radiologic evidence of laRC, documented by abdominal and chest CT and abdominal and pelvic MRI presenting measurable disease and receiving induction chemotherapy according to the Hellenic Society of Medical Oncologists (HeSMO) guidelines (21). Exclusion criteria were as follows: I) Failure to complete the therapeutic regimen for any reason (toxicity, refusal of the patient, or death), II) Refusal of the patient to attend the study III) Synchronous second primary cancer at the time of enrollment and/or therapy.…”

Clinical and Epidemiological Analysis of Malignant Neoplasms of the Abdominal Organs

“…Важливим аспектом діагностики та лікування ЗН є їх морфологічна характеристика. Здійснення морфологічного моніторингу не тільки дає можливість актуалізувати діагноз ЗН, але також є важливим підґрунтям для обрання лікувальної тактики шляхом визначення рецепторів, чистоти країв та вартових лімфовузлів тощо [7]. Проте, за результатами аналізу матеріалів медичної документації, тільки у 62,6% випадків ЗН черевної порожнини були наявні морфологічні підтвердження.…”

Multidisciplinary Cancer Management of Colorectal Cancer in Tikur Anbessa Specialized Hospital, Ethiopia

“…Because of this, the MTB approach for colorectal cancer has been widely accepted and is recommended worldwide as the standard of care in current practice. 12-14 The purpose of this study was to describe the profile of patients discussed in the Tikur Anbessa MTB and the potential benefits brought by multidisciplinary care.…”