Rectal Cancer Practice Guidelines for Radiation Oncology

For our November #radonc #jc we will discuss the role of radiation therapy in management of rectal cancer. In the past 30 years, it has evolved from postoperative therapy to preoperative therapy with selected use of organ preservation without surgery.

Imaging modalities and treatment strategies have evolved substantially, so it’s timely to review how and when radiation therapy may be helpful, as well as how to offer radiation treatments safely.

This coming weekend, we will discuss the recently published ASTRO Clinical Practice Guideline, which is open access on Practical Radiation Oncology:

Wo JY, Anker CJ, Ashman JB, et al. Radiation Therapy for Rectal Cancer: Executive Summary of an ASTRO Clinical Practice Guideline.

Dr. Jennifer Wo, Dr. Jonathan Ashman and Dr. Ann Raldow will join us for November 21-22 starting at 8 AM CST 11/21 for asynchronous chat. The key questions in the article focus upon:

• indications for neoadjuvant radiation;
• options for neoadjuvant regimens;
• the use of local excision or nonoperative management;
• technical delivery of radiation therapy (simulation to technique).

There are 27 recommendations, too many for us to cover each one over the weekend. So we’ll focus on certain areas and hope that you can help us get into the details. Our topics:


T1: Radiation continues to play an important role in treating rectal cancer.

T2: What was the methodology of this study and for which practices and patients is it applicable? Did ASTRO’s grading classification system capture what you think is clinically relevant in rectal cancer?

T3: What has pelvic MRI changed in terms of evaluating rectal cancer patients and for treatment recommendations?

T4: Radiation therapy’s value is in reducing local recurrences of rectal cancer. In this paper, was the recurrence estimate based upon just the rectum or included anywhere in the pelvis?

T5: What is the estimated absolute risk reduction with radiation therapy leading to the decision to offer neoadjuvant radiation in stage II-III rectal cancer?

T6: Conventionally fractionated chemoradiation is standard, but so is short course radiation (25 Gy in 5 fractions). Given the increasing evidence supporting hypofractionation in other diseases, what are the situations in which 5 weeks are preferable to one?

T7: Does the use of total neoadjuvant chemotherapy influence the decision between conventionally fractionated chemoradiation vs. hypofractionated radiation?

T8: Non-operative management is enticing but remains non-standard. What are the critical success factors for a rectal cancer team to be able to offer NOM safely?

T9: Medically inoperable rectal cancer is beyond the scope of this guideline, from the articles included. How similar would NOM be for these patients, who may be elderly or quite ill?

T10: IMRT increases treatment planning complexity to lessen toxicity. To what degree is time/era-related bias a concern in comparing newer techniques to 3D-conformal radiation?

T11: What are the key areas for future research in the clinical use of radiation therapy in rectal cancer? What technological and radiobiological research are most interesting?

T12: The practice guideline does not address supportive care. What are the key areas for future research on lessening the toxicity of pelvic radiation for rectal cancer?

To accomodate all of these questions, we will do an ongoing conversation through the weekend without a live hour for #radonc #jc.

Here are guidelines on how to sign up and participate

• Read our disclaimer for ways to keep it rewarding and professional. If you’re not ready, just lurk and tune into the conversation.
• Don’t forget the #radonc #jc tags!
• If you feel like getting fancy, feel free to add #crcsm to your tweets to share with the colorectal cancer community on twitter. #crcsm is shorthand for colorectal cancer social media.

Any suggestions? Leave a comment or tweet us at @Rad_Nation. And please join us this weekend!