General Session 7: Innovations in Multimodality Management of Rectal Cancer

Daniel T. Chang, MD—Chair, Stanford University

Zhen J. Wang, MD—Chair, University of California San Francisco

Julio Garcia-Aguilar, MD, PhD
Colorectal Service, Department of Surgery, Memorial Sloan-Kettering Cancer Center
Advances in Surgical Management of Patients with Rectal Cancer

Conclusions/Take-Away Points:

• MRI with "rectal protocol" for locoregional staging

• Good surgical technique: TME and APE

• MIS if resources and expertise available

• TAMIS (local excision) for highly selected T1 tumors

• Neoadjuvant therapy and LE an option of T2 tumors

• LPLND for enlarged LPLN (≥7mm) at baseline, particularly if persist (≥4mm) at re-staging MRI

• WW an option for clinical and radiological response after neoadjuvant therapy (best in a clinical trial)


Salma Jabbour, MD
Rutgers Cancer Institute of New Jersey
Radiotherapy for Rectal Cancer—Beyond the German Rectal Trial

Summary: LN Outside the Mesorectum 

• Management of lateral LN

   - LLND may not be possible in all patients

   - Consider optimizing preop therapy with induction chemotherapy or intensification of RT

Take-Horne Points:

• Preoperative CRT

    - Short course RT with a delay to surgery also reasonable

   - Standard of care for Stage II-III rectal cancer

   - Decrease LR and increase sphincter-sparing surgery

• Organ preservation

   - CRT followed by local excision in small early stage, distal tumors (T2N0 or <4 cm)

   - Watchful waiting in patients in carefully selected patients

• Lateral LN may benefit from LLND, ? RT & induction Chemo

Thomas J. George, MD, FACP
University of Florida Health Cancer Center
Expanding the Role of Chemotherapy for Rectal Cancer

Summary:

• Neoadjuvant chemotherapy represents an emerging opportunity to:

   - lmprove delivery of systemic treatment

   - Assess in-vivo biologic response to treatment for clinical decision making AND biomarker development

   - Selectively consider the option of no RT or no Surgery

   - Provide full post-op recovery and/or novel adjuvant treatments

• One size fits all approach CANNOT serve our patient's needs moving forward

Zhen J. Wang, MD
University of California San Francisco
Review of Post-treatment Response