[Therapeutic approach of French practitioners to rectal cancer]

Improvements in treatment of rectal cancer have enabled a better control of locoregional disease. Our objective was to describe the therapeutic decisions of different specialists implied through clinical cases and the influence of their professional characteristics.

In spring 1996, a questionnaire was mailed to a random sample of 621 French physicians, presenting 3 clinical cases of rectal cancer at different stages. The present analysis deals with a clinical case concerning a 46 year-old man bearing a T3N0 tumor, at 7 cm from the anal verge. Statistical analysis (uni and multivariate, by logistic regression) was performed with SPSS software.

Three hundred fifty two exploitable responses were returned (response rate: 57%). Half of the physicians chose a pluridisciplinary decision modality. There were differences according to the speciality (P < 0.003), to the type of practice (public/private) (P < 10(-4)) and to the proximity of specialized units (P = 0.03). Therapeutic attitudes consisted in a combination of radiotherapy and surgery (RT-SU) for 95% of the physicians. The therapeutic choice was in agreement with the French consensus conference for 71% of physicians. Two main attitudes emerged for this clinical case: exclusive RT-SU combination (43.5%) and RT-SU with optional or systematic chemotherapy (CT) (52%). The latter choice appeared to be closely dependent on medical speciality (P = 0.0004) and background (P = 0.002).

Decision making is mainly related to the place of work, whereas the therapeutic attitude depends on physicians' own characteristics. Until 1990, multiple therapeutic options for rectal cancer were performed in France. Nowadays, for a T3N0 tumor, the argumentation is rather focused on the indication of CT combined with the standard RT-SU treatment. Results from ongoing controlled studies will help update consensual recommendations.