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Appropriate customization of radiation therapy for stage II and III rectal cancer: Executive summary of an ASTRO Clinical Practice Statement using the RAND/UCLA Appropriateness Method.

Publication ,  Journal Article
Goodman, KA; Patton, CE; Fisher, GA; Hoffe, SE; Haddock, MG; Parikh, PJ; Kim, J; Baxter, NN; Czito, BG; Hong, TS; Herman, JM; Crane, CH; Hoffman, KE
Published in: Pract Radiat Oncol
2016

PURPOSE: To summarize results of a Clinical Practice Statement on radiation therapy for stage II-III rectal cancer, which addressed appropriate customization of (neo)adjuvant radiation therapy and use of non-surgical therapy for patients who are inoperable or refuse abdominoperineal resection. METHODS AND MATERIALS: The RAND/University of California, Los Angeles, Appropriateness Method was applied to combine current evidence with multidisciplinary expert opinion. A systematic literature review was conducted and used by the expert panel to rate appropriateness of radiation therapy options for different clinical scenarios. Treatments were categorized by median rating as Appropriate, May Be Appropriate, or Rarely Appropriate. RESULTS: In the neoadjuvant setting, chemoradiation was rated Appropriate and the ratings indicated short-course radiation therapy, chemotherapy alone, and no neoadjuvant therapy are potential options in selected patients. However, neoadjuvant endorectal brachytherapy was rated Rarely Appropriate. For adjuvant therapy, chemoradiation (plus ≥4 months of chemotherapy) was rated Appropriate and chemotherapy alone May Be Appropriate for most scenarios. For medically inoperable patients, definitive external beam radiation therapy and chemotherapy alone were rated May Be Appropriate, whereas endorectal brachytherapy and chemoradiation plus endorectal brachytherapy were possible approaches for some scenarios. The last option, definitive chemoradiation, was rated Appropriate to May Be Appropriate based on performance status. Finally, for patients with low-lying tumors refusing abdominoperineal resection, definitive chemoradiation alone, chemoradiation plus endorectal brachytherapy, and chemoradiation plus external beam radiation therapy were all rated Appropriate. CONCLUSIONS: This Clinical Practice Statement demonstrated the central role of radiation therapy in stage II-III rectal cancer management and evaluated ways to better individualize its use in the neoadjuvant, adjuvant, and definitive settings. Ongoing trials may clarify areas of continuing uncertainty and allow further customization.

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Published In

Pract Radiat Oncol

DOI

EISSN

1879-8519

Publication Date

2016

Volume

6

Issue

3

Start / End Page

166 / 175

Location

United States

Related Subject Headings

  • Rectal Neoplasms
  • Neoplasm Staging
  • Neoadjuvant Therapy
  • Humans
  • 3211 Oncology and carcinogenesis
  • 3202 Clinical sciences
 

Citation

APA
Chicago
ICMJE
MLA
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Goodman, K. A., Patton, C. E., Fisher, G. A., Hoffe, S. E., Haddock, M. G., Parikh, P. J., … Hoffman, K. E. (2016). Appropriate customization of radiation therapy for stage II and III rectal cancer: Executive summary of an ASTRO Clinical Practice Statement using the RAND/UCLA Appropriateness Method. Pract Radiat Oncol, 6(3), 166–175. https://doi.org/10.1016/j.prro.2015.11.014
Goodman, Karyn A., Caroline E. Patton, George A. Fisher, Sarah E. Hoffe, Michael G. Haddock, Parag J. Parikh, John Kim, et al. “Appropriate customization of radiation therapy for stage II and III rectal cancer: Executive summary of an ASTRO Clinical Practice Statement using the RAND/UCLA Appropriateness Method.Pract Radiat Oncol 6, no. 3 (2016): 166–75. https://doi.org/10.1016/j.prro.2015.11.014.
Goodman, Karyn A., et al. “Appropriate customization of radiation therapy for stage II and III rectal cancer: Executive summary of an ASTRO Clinical Practice Statement using the RAND/UCLA Appropriateness Method.Pract Radiat Oncol, vol. 6, no. 3, 2016, pp. 166–75. Pubmed, doi:10.1016/j.prro.2015.11.014.
Goodman KA, Patton CE, Fisher GA, Hoffe SE, Haddock MG, Parikh PJ, Kim J, Baxter NN, Czito BG, Hong TS, Herman JM, Crane CH, Hoffman KE. Appropriate customization of radiation therapy for stage II and III rectal cancer: Executive summary of an ASTRO Clinical Practice Statement using the RAND/UCLA Appropriateness Method. Pract Radiat Oncol. 2016;6(3):166–175.
Journal cover image

Published In

Pract Radiat Oncol

DOI

EISSN

1879-8519

Publication Date

2016

Volume

6

Issue

3

Start / End Page

166 / 175

Location

United States

Related Subject Headings

  • Rectal Neoplasms
  • Neoplasm Staging
  • Neoadjuvant Therapy
  • Humans
  • 3211 Oncology and carcinogenesis
  • 3202 Clinical sciences