علاج سرطان المستقيم الموضعي في الثلث السفلي أو الأوسط من المستقيم بقصد الحفاظ على العضو

References

• Management of localised rectal cancer located in the lower or middle third of the rectum when organ preservation is intended.
• Multimodal treatment strategies for patients with rectal cancer are increasingly incorporating a watch-and-wait approach for organ preservation.
• SCRT or CRT can be recommended for patients with cT1-cT2 N0 tumours [II, B].
• Standard external CRT followed by RT dose escalation using endorectal brachytherapy is recommended for patients with cT1-cT2 N+ or cT3 N0-1 tumours <5 cm [I, A].
• TNT is recommended for patients with high-risk criteria and patients with cT2 N+ or cT3 Nany tumours [I, A].
• Upfront CRT followed by consolidation ChT can be recommended to increase the likelihood of cCR [I, B].
• RT should be offered as long-course CRT (50-50.4 Gy in 25-28 fractions with concomitant capecitabine or infusional 5-FU) or SCRT (25 Gy in five fractions) [I, A].
• Consolidation or induction ChT (CAPOX or FOLFOX) should be administered for 3-4.5 months [I, A].
• 12 weeks after the start of RT in SCRT or CRT; in case of near cCR, further restaging can be recommended after another 4-8 weeks [I, B].
• The cCR is assessed by a combination of DRE, sigmoidoscopy and MRI to assess the MRI tumour regression grade.