Factors affecting management decisions in rectal cancer in clinical practice: results from a national survey
Carregando...
Citações na Scopus
12
Tipo de produção
article
Data de publicação
2011
Editora
SPRINGER
Indexadores
Título da Revista
ISSN da Revista
Título do Volume
Autores
Autor de Grupo de pesquisa
Editores
Coordenadores
Organizadores
Citação
TECHNIQUES IN COLOPROCTOLOGY, v.15, n.1, p.45-51, 2011
Resumo
Management of rectal cancer has become increasingly complex and a multidisciplinary approach is considered of key importance for improving outcomes. A national survey among specialists involved in this multidisciplinary setting was performed. A web-based survey containing 11 questions regarding rectal cancer management was sent to surgeons and medical oncologists registered by their corresponding societies as members. Statistical analysis was performed using the chi-square and Fisher's exact tests for all categorical variables according to response to individual questions. Multivariate analysis was performed using Cox's logistic regression. Overall, 418 email recipients responded the survey. Local staging was performed without either magnetic resonance imaging or endorectal ultrasound by 64% of responders. Seventy-two percent considered that final management decision should be made after neoadjuvant chemoradiation therapy. Additionally, 46% considered that an alternative procedure (local excision or observation) was appropriate in a patient with a complete clinical response. Colorectal surgeons were more frequently in favor of longer intervals after completion of chemoradiation therapy (P = 0.001) and of alternative management procedures after a complete clinical response (P = 0.02). After multivariate analysis, the choice of a watch and wait approach after a complete clinical response following neoadjuvant chemoradiation therapy was significantly more frequent among surgeons (OR 3.5, 95% CI 1.8-7.1). Surgeons seem to be more in favor of tailoring management of rectal cancer according to tumor response after neoadjuvant chemoradiation therapy, with longer intervals after chemoradiation therapy, decisions about treatment strategy being made after chemoradiation therapy instead of before, and the use of alternative surgical procedures after a complete clinical response following neoadjuvant therapy.
Palavras-chave
Rectal cancer, Neoadjuvant therapy, Minimally invasive therapy
Referências
- Zerhouni EA, 1996, RADIOLOGY, V200, P443
- Moore HG, 2004, DIS COLON RECTUM, V47, P279, DOI 10.1007/s10350-003-0062-1
- Bartram C, 2002, GASTROENTEROL CLIN N, V31, P827, DOI 10.1016/S0889-8553(02)00027-4
- Guillem JG, 2005, ANN SURG, V241, P829, DOI 10.1097/01.sla.0000161980.46459.96
- Gualdi GF, 2000, DIS COLON RECTUM, V43, P338, DOI 10.1007/BF02258299
- Brown G, 2003, BRIT J SURG, V90, P355, DOI 10.1002/bjs.4034
- Glynne-Jones R, 2008, DIS COLON RECTUM, V51, P10, DOI 10.1007/s10350-007-9080-8
- Ota DM, 2007, ANN SURG ONCOL, V14, P271, DOI 10.1245/s10434-006-9213-7
- Nagtegaal ID, 2005, J CLIN ONCOL, V23, P9257, DOI 10.1200/JCO.2005.02.9231
- Sauer R, 2004, NEW ENGL J MED, V351, P1731, DOI 10.1056/NEJMoa040694
- Habr-Gama A, 2009, BRIT J SURG, V96, P125, DOI 10.1002/bjs.6470
- Pomerri F, 2009, EJSO-EUR J SURG ONC, V35, P168, DOI 10.1016/j.ejso.2008.02.006
- Wynn GR, 2010, COLORECTAL DIS, V12, P327, DOI 10.1111/j.1463-1318.2009.01962.x
- Tjandra JJ, 2005, DIS COLON RECTUM, V48, P411, DOI 10.1007/s10350-004-0937-9
- Tulchinsky H, 2008, ANN SURG ONCOL, V15, P2661, DOI 10.1245/s10434-008-9892-3
- Beart RW, 2007, CLIN CANCER RES, V13, p6890S, DOI 10.1158/1078-0432.CCR-07-1135
- Bonadeo FA, 2001, DIS COLON RECTUM, V44, P374, DOI 10.1007/BF02234736
- Glynne- Jones R, 2008, DIS COLON RECTUM, V51, P19
- Guillem JG, 2005, ANN SURG, V241, P836
- Madoff RD, 2009, LANCET, V373, P790, DOI 10.1016/S0140-6736(09)60459-1
- Minsky BD, 2008, ONCOLOGY-NY, V22, P1430
- NICHOLLS RJ, 1982, BRIT J SURG, V69, P404, DOI 10.1002/bjs.1800690716