Management of Locally Advanced Rectal Cancer: ASCO Guideline.

Area of Science:

• Gastrointestinal Oncology
• Clinical Practice Guidelines
• Evidence-Based Medicine

Background:

• Locally advanced rectal cancer (LARC) requires tailored treatment strategies.
• Evolving treatment paradigms necessitate updated clinical guidance.
• ASCO guidelines synthesize evidence for optimal patient care.

Purpose of the Study:

• To establish evidence-based recommendations for LARC management.
• To guide clinicians in selecting appropriate treatment modalities.
• To incorporate recent advancements in rectal cancer therapy.

Main Methods:

• Systematic literature review from 2013-2023.
• Inclusion of randomized controlled trials (RCTs), systematic reviews, and observational studies.
• Expert panel consensus development based on reviewed evidence.

Main Results:

• Total neoadjuvant therapy (TNT) recommended for high-risk LARC (microsatellite stable/proficient mismatch repair) with lower rectal tumors or metastatic risk.
• Chemotherapy timing preference: post-radiation in TNT. Neoadjuvant long-course chemoradiation (CRT) preferred over short-course RT, but short-course RT is viable.
• Immunotherapy recommended for microsatellite instability-high/mismatch repair deficient tumors. Nonoperative management is an option for clinical complete responders.

Conclusions:

• Updated ASCO guidelines provide comprehensive recommendations for LARC.
• TNT is a key strategy for high-risk patients.
• Personalized treatment approaches, including immunotherapy and nonoperative management, are emphasized.