Treatment of Patients With Early-Stage Colorectal Cancer: ASCO Resource-Stratified Guideline

Abstract

PURPOSE To provide resource-stratified, evidence-based recommendations on the treatment and follow-up of patients with early-stage colorectal cancer. METHODS ASCO convened a multidisciplinary, multinational Expert Panel that reviewed existing guidelines and conducted a modified ADAPTE process and a formal consensus process with additional experts for one round of formal ratings. RESULTS Existing sets of guidelines from 12 guideline developers were identified and reviewed; adapted recommendations from six guidelines form the evidence base and provide evidence to inform the formal consensus process, which resulted in agreement of 75% or more on all recommendations. RECOMMENDATIONS For nonmaximal settings, the recommended treatments for colon cancer stages nonobstructing, I-IIA: in basic and limited, open resection; in enhanced, adequately trained surgeons and laparoscopic or minimally invasive surgery, unless contraindicated. Treatments for IIB-IIC: in basic and limited, open en bloc resection following standard oncologic principles, if not possible, transfer to higher-level facility; in emergency, limit to life-saving procedures; in enhanced, laparoscopic en bloc resection, if not possible, then open. Treatments for obstructing, IIB-IIC: in basic, resection and/or diversion; in limited or enhanced, emergency surgical resection. Treatment for IIB-IIC with left-sided: in enhanced, may place colonic stent. Treatment for T4N0/T3N0 high-risk features or stage II high-risk obstructing: in enhanced, may offer adjuvant chemotherapy. Treatment for rectal cancer cT1N0 and cT2n0: in basic, limited, or enhanced, total mesorectal excision principles. Treatment for cT3n0: in basic and limited, total mesorectal excision, if not, diversion. Treatment for high-risk patients who did not receive neoadjuvant chemotherapy: in basic, limited, or enhanced, may offer adjuvant therapy. Treatment for resectable cT3N0 rectal cancer: in enhanced, base neoadjuvant chemotherapy on preoperative factors. For post-treatment surveillance, a combination of medical history, physical examination, carcinoembryonic antigen testing, imaging, and endoscopy is performed. Frequency depends on setting. Maximal setting recommendations are in the guideline. Additional information can be found at www.asco.org/resource-stratified-guidelines . NOTICE It is the view of the American Society of Clinical Oncology that health care providers and health care system decision makers should be guided by the recommendations for the highest stratum of resources available. The guidelines are intended to complement but not replace local guidelines.

Early Detection for Colorectal Cancer: ASCO Resource-Stratified Guideline

“…Palliative Care in the Global Setting (http://ascopubs.org/doi/10.1200/JGO.18.00026) 26 Patient-Clinician Communication (http://ascopubs.org/doi/10.1200/JCO.2017.75.2311) 27 Treatment of Patients With Early-Stage Colorectal Cancer (http://ascopubs.org/doi/10.1200/JGO.18.00214) 28 …”

Addressing the variation in adjuvant chemotherapy treatment for colorectal cancer: Can a regional intervention promote national change?

“…European Society for Medical Oncology (ESMO) guidance. [7][8][9] More recently the duration of treatment has been further shortened to 3 months; the evidence strongest when using oxaliplatin and capecitabine (CAPOX) but the shorter course can still be considered for single agent capecitabine or oxaliplatin and 5FU (FOLFOX). 10,11 Again, ASCO and NCCN guidelines quickly adopted these changes as a new standard of care for all except patients with high-risk Stage III disease where 6 months is still recommended.…”

An easily adaptable validated risk score predicts cancer-specific survival in stage II colon cancer

“…High-risk stage II colon cancer is defined in European and American guidelines as the presence of at least one of the following high-risk factors: T4 stage, tumor differentiation grade 3, bowel obstruction or perforation, presence of lymphovascular invasion (LVI), or <12 investigated lymph nodes [1][2][3]. Perineural invasion (PNI), high tumor budding and compromised surgical margin are also strong predictors of disease recurrence [3][4][5][6].…”