ARLINGTON, Va., July 21, 2016 – The American Society for Radiation Oncology (ASTRO) recently issued a new clinical practice statement, "Appropriate Customization of Radiation Therapy for Stage II and III Rectal Cancer: An ASTRO Clinical Practice Statement Using the RAND/UCLA Appropriateness Method." An executive summary of the guideline was published in the May-June 2016 issue of Practical Radiation Oncology (PRO), ASTRO's clinical practice journal, and the full guideline is available as an open-access online article in PRO.

The clinical practice statement, which was developed by a multidisciplinary expert working group, outlines recommendations to customize neoadjuvant and adjuvant radiation therapy for patients with moderately advanced rectal cancer based on their risk of recurrence. The statement also examines non-operative therapies for patients who are medically inoperable or refuse abdominoperineal resection, taking into account the emerging technologies available for this subset of patients.

The standard of care for all patients with stage II-III rectal cancer has been a combined multi-modality approach of chemotherapy, radiation therapy (RT) and surgery, as established in a 1990 consensus statement from the National Cancer Institute (NCI). This standard, however, is based on data collected in the 1970s and 1980s, when both RT and chemotherapy were necessary to reduce the high risk of local recurrence following less sophisticated forms of surgery. Advancements in treatment options over the past three decades -- including more refined surgical techniques, more effective systemic agents and more focal and shorter-course RT options -- have drastically lowered recurrence rates, creating situations where one or more modalities may be omitted and the side effects of treatment may be reduced.
"This statement provides practicing physicians with an idea of how to employ alternative treatment options for rectal cancer patients, such as short-course radiation therapy or non-operative management approaches. It also lets us identify patients who may be more amenable to different treatment sequencing options, rather than grouping everyone with stage II and III rectal cancer together for a single standard tri-modal treatment approach. There are cases where we can achieve the same survival benefit with less treatment," said Karyn A. Goodman, MD, an associate professor of radiation oncology at the University of Colorado and lead author of the practice statement's executive summary.

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