ESMO E-Learning: Perioperative Treatment of Locally Advanced Rectal Cancer

Learning Objectives

  1. To explain the rationale for short course chemoradiation for rectal cancer
  2. To explain the limitations of short course chemoradiation for rectal cancer
  3. To explain how to select patients suitable for short course/long course chemoradiation
  4. To explain the role of postoperative adjuvant chemotherapy after chemoradiation and after surgery alone
  5. Ability to tailor the treatment to the individual patient

 

Title Duration Content CME Points CME Test
Perioperative Treatment of Locally Advanced Rectal Cancer 101 min. 100 slides 1 Take Test
glynne-jones-robert
Robert Glynne Jones
Read more

In this E-learning module, an international expert in the management of rectal cancer discusses the evidence base for the perioperative treatment in the locally advanced setting. The areas covered range from preoperative assessment, indications for treatment, surgery, radiotherapy options, chemotherapy drugs, interval to surgery and acute and late effects.

This module elaborates the state of the art treatment from historic to current perspective, illustrated by results from the randomised clinical studies.

Treatment of rectal cancer is demanding and requires highly skilled practice by the entire multidisciplinary team. Competent surgery and good pathology as well as sound radiation techniques and optimally given chemotherapy, together with long-term complete follow-up including also functional aspects, are important for quality management.

An important treatment aim is to achieve a very low risk of residual disease in the pelvis, as local recurrence is frequently disabling. Another aim is a treatment strategy that helps to preserve a good sphincter function.

Factors other than clinical T stage, such as tumour height, anterior location, proximity of the tumour or lymph node growths to the mesorectal fascia, size of the mesorectum, cN stage and vascular and nerve invasion, are very relevant. The presence of extramural vascular invasion is a poor prognostic signal for the development of distant metastases, and possibly also local failure.

Through the elaboration of different clinically relevant aspects, the author tries to give an answer on treatment strategies, although it is presently not possible to give a precise definition of different clinical subgroups of rectal cancer.

By elaborating radiotherapy and chemotherapy options in relation to surgery, the author provides current therapeutic wisdom in the management of locally advanced rectal cancer.

Last update: 22 December 2016

Dr Glynne-Jones has reported honoraria for lectures from Merck and Servier in 2015. Advisory Board member of Eli Lilly, Roche, Home Nutrition in 2015 and of Servier, Eisai and Amgen in 2016.