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Implementation of Organ Preservation for Locally Advanced Rectal Cancer in Canada: A National Survey of Clinical
Megan Delisle1, Victoria Ivankovic2, Doris Goubran3
1Department of Surgery, University of Manitoba, Winnipeg, MB R3E 0W3, Canada.
Purpose:
Organ preservation (OP) is an increasingly recognized treatment for locally advanced rectal cancer. However, variability in patient selection, treatment regimens, and surveillance can hinder widespread adoption. We conducted a national, cross-sectional survey evaluating how OP is implemented across Canada.
Methods:
Between June and July 2023, surgeons, radiation oncologists, and medical oncologists with expertise in OP from all 44 Canadian radiation centers completed an electronic survey about the implementation of OP at their centers. Primary OP was defined as administering neoadjuvant therapy with the explicit goal of avoiding surgery. Secondary OP was defined as deferring planned surgery only when there was an unexpected yet sufficient clinical response.
Results:
Responses from 40 radiation centers (response rate 90.9%) identified that 20 (50.0%) offered primary and secondary OP, 11 (27.8%) offered only secondary, and 8 (20.0%) offered neither. The most common treatment in primary OP was chemoradiation with consolidation chemotherapy (17/20, 89.5%). When assessing the response in primary OP, endoscopic biopsies were more commonly performed with a near-complete response (10/20, 50.0%) than a complete response (4/20, 20.0%). Watch-and-wait surveillance was more frequently offered for a complete response (17/31, 54.8%) than a near-complete response (4/31, 12.9%). Challenges included limited MRI (21/40, 52.5%), clinic time (18/40, 45.0%), timely surgery if required (16/40, 40.0%), and limited familiarity with the protocols and evidence (15/40, 37.5%).
Conclusion:
OP is recognized nationwide but is inconsistently implemented. Challenges raise concerns about the current feasibility of OP in Canada and highlight the need for less resource-intensive, complex OP protocols.
Insights
Organ preservation (OP) for rectal cancer is recognized but inconsistently applied in Canada. Challenges with resources and protocols need addressing for wider adoption of this surgical alternative.
Area of Science:
- Oncology
- Surgical Oncology
- Radiation Oncology
Background:
- Organ preservation (OP) is gaining recognition for treating locally advanced rectal cancer.
- Variability in patient selection, treatment, and surveillance hinders widespread OP adoption.
Purpose of the Study:
- To survey the national implementation of organ preservation strategies across Canada.
- To identify current practices, challenges, and variations in OP for rectal cancer.
Main Methods:
- A national cross-sectional electronic survey was conducted among specialists in Canadian radiation centers (June-July 2023).
- Primary OP involved neoadjuvant therapy to avoid surgery; secondary OP deferred surgery based on response.
- Data collected on OP offerings, treatment regimens, response assessment, and implementation challenges.
Main Results:
- 50% of centers offered both primary and secondary OP; 27.8% offered only secondary OP.
- Chemoradiation with consolidation chemotherapy was common in primary OP (89.5%).
- Challenges included limited MRI (52.5%), clinic time (45.0%), timely surgery (40.0%), and protocol familiarity (37.5%).
Conclusions:
- Organ preservation is recognized nationally but implemented inconsistently across Canada.
- Significant challenges exist regarding resources and protocol familiarity, impacting OP feasibility.
- Development of less resource-intensive OP protocols is needed for broader Canadian implementation.
