This article appears in the following Annals of Oncology issue: ESMO International Symposium: 10th World Congress on Gastrointestinal Cancer 25-28 June, 2008: Barcelona, Spain [View the issue table of contents]
symposium article |
The diagnosis and management of rectal cancer: expert discussion and recommendations derived from the 9th World Congress on Gastrointestinal Cancer, Barcelona, 2007
1 University Hospital Gasthuisberg, Leuven, Belgium
2 Luxembourg Medical Center, Luxembourg
3 Tel Aviv Medical Center and Sackler School of Medicine, Tel Aviv University, Israel
4 CHU Jean-Minjoz, Besançon, France
5 The Royal Marsden Hospital, Surrey, UK
6 Hôpital Saint-Antoine, Paris, France
7 San Carlos Hospital Clinioc, Madrid, Spain
8 Institut Gustave Roussy, Villejuif, France
9 University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
10 Mount Vernon Cancer Centre, Northwood, UK
11 Abramson Cancer Center at the University of Pennsylvania, Philadelphia, USA
12 Asan Medical Center, Seoul, South-Korea
13 University of Oxford, Oxford, UK
14 Ospedale Riuniti, Bergamo, Italy
15 University of Chicago Medical Center, Chicago, IL, USA
16 Princess Margaret Hospital, Toronto, Ontario, Canada
17 Hôpital Ambroise Paré, Boulogne, France
18 Medical University Vienna, Vienna, Austria
19 Martin Luther Universität, Halle, Germany
20 Ospedale San Martino, Genoa, Italy
21 Vall d'Hebron University Hospital, Barcelona, Spain
22 University of California, San Francisco, California, USA
23 Leiden University Medical Center, Leiden, The Netherlands
24 Peter MacCallum Cancer Centre and Department of Medicine, Melbourne, Australia
* Correspondence to: Prof. Eric Van Cutsem, Digestive Oncology Unit, University Hospital Gasthuisberg, Herestraat 49, 3000 Leuven, Belgium. Tel: +32-16-344225; Fax: +32-16-344419; E-mail: Eric.VanCutsem{at}uz.kuleuven.ac.be
Knowledge of the biology and management of rectal cancer continues to improve. A multidisciplinary approach to a patient with rectal cancer by an experienced expert team is mandatory, to assure optimal diagnosis and staging, surgery, selection of the appropriate neo-adjuvant and adjuvant strategy and chemotherapeutic management. Moreover, optimal symptom management also requires a dedicated team of health care professionals. The introduction of total mesorectal excision has been associated with a decrease in the rate of local failure after surgery. High quality surgery and the achievement of pathological measures of quality are a prerequisite to adequate locoregional control. There are now randomized data in favour of chemoradiotherapy or short course radiotherapy in the preoperative setting. Preoperative chemoradiotherapy is more beneficial and has less toxicity for patients with resectable rectal cancer than postoperative chemoradiotherapy. Furthermore chemoradiotherapy leads also to downsizing of locally advanced rectal cancer. New strategies that decrease the likelihood of distant metastases after initial treatment need be developed with high priority. Those involved in the care for patients with rectal cancer should be encouraged to participate in well-designed clinical trials, to increase the evidence-based knowledge and to make further progress. Health care workers involved in the care of rectal cancer patients should be encouraged to adopt quality control processes leading to increased expertise.
Key words: rectal cancer, surgery, chemotherapy, radiotherapy