Radiotherapy guidelines for rectal cancer in China (2020 Edition)

Abstract

Rectal cancer is one of the most common malignant tumors. In China, rectal cancer has been the third most frequently diagnosed cancer and the fifth leading cause of cancer death, with changes of residents’ lifestyle factors and diets. The best treatment for rectal cancer depends on many factors. Multidisciplinary Treatment has become the basis for improving the therapeutic effect, in which radiology is increasingly necessary for treating patients with rectal cancer. For patients who have extensive, fixed, bulky tumors or obvious nodal disease, radiotherapy and chemotherapy combined with surgery has emerged as the standard of care. For patients with metastatic disease, the reasonable combination of local and systemic therapy might be an alternative. Improvements in imaging, pathological diagnosis and radiation techniques provide a solid foundation for promoting the level of clinical practice in rectal cancer. High‐quality magnetic resonance imaging distinguishing risk stratification, molecular markers predicting therapeutic effect and prognosis, magnetic resonance imaging in delineating target volumes drawn, intensity‐modulated radiation therapy, and image‐guides radiation therapy for precision treatment delivery are all being widely applied in multiple centers. Furthermore, as the role of targeted therapy and immune therapy has become increasingly prominent, the attempt of combined radiotherapy is also ongoing. In view of the characteristics and current situation of diagnosis and treatment of rectal cancer in China, the guidelines will present the basis and reference for combined treatment and standardized treatments. Meanwhile, there may be continuous new advances in clinical practice, and that will be a new basis to update the guidelines, directly benefiting all rectal cancer patients and facilitating discipline developments.

Total neoadjuvant treatment and PD-1/PD-L1 checkpoint inhibitor in locally advanced rectal cancer

“…In recent years, the administration of immunotherapy combined with TNT or TNTlike treatment has become a hot research topic. As reported by Jing Jin et al, treatment guidelines in the China also recommend TNT as an option for LARC patients (3). Our team also performed a comprehensive meta-analysis to determine the roles of TNT in improving the pathologic complete response (pCR) and survival value compared with standard CRT among LARC patients (4).…”

Cost‐effectiveness analysis of CYP2C19 genotype‐guided antiplatelet therapy for patients with acute minor ischemic stroke and high‐risk transient ischemic attack in China

“…The primary outcomes are presented as the incremental cost‐effectiveness ratio (ICER), where the numerator is the difference in total costs and the denominator is the difference in health outcomes between the two strategies. CYP2C19 genotype‐guided antiplatelet therapy was considered cost‐effective when the ICER was less than the willingness‐to‐pay threshold (31 240 USD/QALY), which is defined as three‐fold per capita gross domestic product (GDP), 40 according to relevant pharmacoeconomic evaluations guidelines 42 …”

The safety of an MRI simulation-guided boost after short-course preoperative radiotherapy for unresectable rectal cancer (SUNRISE): interim analysis of a randomized phase II trial

“…The clinical target volume (CTV) contained the GTV, mesorectum and high-risk regional lymph nodes. The PTV and PGTV were derived from the CTV and GTV plus 1 cm in the cranio-caudal direction and 0.7 cm in the anterior-posterior and left-right directions [ 13 ]. Volumetric modulated arc therapy (VMAT) was recommended during radiotherapy.…”

“…Volumetric modulated arc therapy (VMAT) was recommended during radiotherapy. Delineation of the primary organs at risk (OARs) was determined according to the RTOG guidelines [ 14 ] and the dose limitations were as follows: in the experimental group, V25 femur head < 5%, V25 bladder < 50%, V25 colon < 10%, Dmax colon < 27 Gy, V25 small bowel < 10%, and Dmax small bowel < 27 Gy; in the control group, V50 femur head < 5%, V50 bladder < 50%, V50 colon < 20%, Dmax colon < 60 Gy, V50 small bowel < 20%, and Dmax small bowel < 55 Gy [ 13 , 15 ]. During the IGRT treatment, patients in the experimental group received cone beam computed tomography (CBCT) scans before each fraction.…”