International consensus recommendations on key outcome measures for organ preservation after (chemo)radiotherapy in patients with rectal cancer.

Chemoradiotherapy / adverse effects Consensus Delphi Technique Humans Organ Preservation / standards Rectal Neoplasms / therapy

Journal

Nature reviews. Clinical oncology
ISSN: 1759-4782
Titre abrégé: Nat Rev Clin Oncol
Pays: England
ID NLM: 101500077

Informations de publication

Date de publication:
12 2021
Historique:
accepted: 16 06 2021
pubmed: 6 8 2021
medline: 24 12 2021
entrez: 5 8 2021
Statut: ppublish

Résumé

Multimodal treatment strategies for patients with rectal cancer are increasingly including the possibility of organ preservation, through nonoperative management or local excision. Organ preservation strategies can enable patients with a complete response or near-complete clinical responses after radiotherapy with or without concomitant chemotherapy to safely avoid the morbidities associated with radical surgery, and thus to maintain anorectal function and quality of life. However, standardization of the key outcome measures of organ preservation strategies is currently lacking; this includes a lack of consensus of the optimal definitions and selection of primary end points according to the trial phase and design; the optimal time points for response assessment; response-based decision-making; follow-up schedules; use of specific anorectal function tests; and quality of life and patient-reported outcomes. Thus, a consensus statement on outcome measures is necessary to ensure consistency and facilitate more accurate comparisons of data from ongoing and future trials. Here, we have convened an international group of experts with extensive experience in the management of patients with rectal cancer, including organ preservation approaches, and used a Delphi process to establish the first international consensus recommendations for key outcome measures of organ preservation, in an attempt to standardize the reporting of data from both trials and routine practice in this emerging area.

Identifiants

DOI: 10.1038/s41571-021-00538-5 PMID: 34349247
pubmed: 34349247
doi: 10.1038/s41571-021-00538-5
pii: 10.1038/s41571-021-00538-5
doi:

Types de publication

Journal Article Research Support, Non-U.S. Gov't Review

Langues

eng

Sous-ensembles de citation

IM

Pagination

805-816

Subventions

Organisme : Cancer Research UK
ID : CRUK/28301
Pays : United Kingdom

Informations de copyright

© 2021. Springer Nature Limited.

Références

Beets, G. L., Figueiredo, N. F. & Beets-Tan, R. G. Management of rectal cancer without radical resection. Annu. Rev. Med. 68, 169–182 (2017).
pubmed: 27618750 doi: 10.1146/annurev-med-062915-021419
Habr-Gama, A. et al. Operative versus nonoperative treatment for stage 0 distal rectal cancer following chemoradiation therapy: long-term results. Ann. Surg. 240, 711–718 (2004).
pubmed: 15383798 pmcid: 1356472 doi: 10.1097/01.sla.0000141194.27992.32
Habr-Gama, A. et al. Organ preservation in cT2N0 rectal cancer after neoadjuvant chemoradiation therapy: the impact of radiation therapy dose-escalation and consolidation chemotherapy. Ann. Surg. 269, 102–107 (2019).
pubmed: 28742703 doi: 10.1097/SLA.0000000000002447
Maas, M. et al. Wait-and-see policy for clinical complete responders after chemoradiation for rectal cancer. J. Clin. Oncol. 29, 4633–4640 (2011).
pubmed: 22067400 doi: 10.1200/JCO.2011.37.7176
Martens, M. H. et al. Long-term outcome of an organ preservation program after neoadjuvant treatment for rectal cancer. J. Natl Cancer Inst. 108, djw171 (2016).
pubmed: 27509881 doi: 10.1093/jnci/djw171
Renehan, A. G. et al. Watch-and-wait approach versus surgical resection after chemoradiotherapy for patients with rectal cancer (the OnCoRe project): a propensity-score matched cohort analysis. Lancet Oncol. 17, 174–183 (2016).
pubmed: 26705854 doi: 10.1016/S1470-2045(15)00467-2
Appelt, A. L. et al. High-dose chemoradiotherapy and watchful waiting for distal rectal cancer: a prospective observational study. Lancet Oncol. 16, 919–927 (2015).
pubmed: 26156652 doi: 10.1016/S1470-2045(15)00120-5
van der Valk, M. J. M. et al. Long-term outcomes of clinical complete responders after neoadjuvant treatment for rectal cancer in the International Watch & Wait Database (IWWD): an international multicentre registry study. Lancet 391, 2537–2545 (2018).
pubmed: 29976470 doi: 10.1016/S0140-6736(18)31078-X
Rullier, E. et al. Organ preservation for rectal cancer (GRECCAR 2): a prospective, randomised, open-label, multicentre, phase 3 trial. Lancet 390, 469–479 (2017).
pubmed: 28601342 doi: 10.1016/S0140-6736(17)31056-5
Smith, J. J. et al. Assessment of a watch-and-wait strategy for rectal cancer in patients with a complete response after neoadjuvant therapy. JAMA Oncol. 5, e185896 (2019).
pubmed: 30629084 pmcid: 6459120 doi: 10.1001/jamaoncol.2018.5896
Dossa, F., Chesney, T. R., Acuna, S. A. & Baxter, N. N. A watch-and-wait approach for locally advanced rectal cancer after a clinical complete response following neoadjuvant chemoradiation: a systematic review and meta-analysis. Lancet Gastroenterol. Hepatol. 2, 501–513 (2017).
pubmed: 28479372 doi: 10.1016/S2468-1253(17)30074-2
Rullier, E. et al. Organ preservation with chemoradiotherapy plus local excision for rectal cancer: 5-year results of the GRECCAR 2 randomised trial. Lancet Gastroenterol. Hepatol. 5, 465–474 (2020).
pubmed: 32043980 doi: 10.1016/S2468-1253(19)30410-8
Stijns, R. C. H. et al. Long-term oncological and functional outcomes of chemoradiotherapy followed by organ-sparing transanal endoscopic microsurgery for distal rectal cancer: the CARTS study. JAMA Surg. 154, 47–54 (2019).
pubmed: 30304338 doi: 10.1001/jamasurg.2018.3752
Bach, S. P. et al. Radical surgery versus organ preservation using short-course radiotherapy followed by transanal endoscopic microsurgery for early-stage rectal cancer (TREC): a randomised, open-label feasibility study. Lancet Hepatol. Gastroenterol. 6, 92−105 (2020).
doi: 10.1016/S2468-1253(20)30333-2
Allaix, M. E., Arezzo, A. & Morino, M. Transanal endoscopic microsurgery for rectal cancer: T1 and beyond? An evidence-based review. Surg. Endosc. 30, 4841–4852 (2016).
pubmed: 26902614 doi: 10.1007/s00464-016-4818-9
Atallah, C. et al. Local excision for T1 rectal tumours: are we getting better? Colorectal Dis. 22, 2038–2048 (2020).
pubmed: 32886836 doi: 10.1111/codi.15344
Glynne-Jones, R. et al. Rectal cancer: ESMO clinical practice guidelines for diagnosis, treatment and follow-up. Ann. Oncol. 28, iv22–iv40 (2017).
pubmed: 28881920 doi: 10.1093/annonc/mdx224
Bellera, C. A. et al. Protocol of the Definition for the Assessment of Time-to-event Endpoints in CANcer trials (DATECAN) project: formal consensus method for the development of guidelines for standardised time-to-event endpoints’ definitions in cancer clinical trials. Eur. J. Cancer 49, 769–781 (2013).
pubmed: 23122780 doi: 10.1016/j.ejca.2012.09.035
Fokas, E. et al. Outcome measures in multimodal rectal cancer trials. Lancet Oncol. 21, e252–e264 (2020).
pubmed: 32359501 doi: 10.1016/S1470-2045(20)30024-3
Benson, A. B. et al. NCCN guidelines insights: rectal cancer, version 6.2020. J. Natl Compr. Canc. Netw. 18, 806–815 (2020).
pubmed: 32634771 doi: 10.6004/jnccn.2020.0032
Wo, J. Y. et al. Radiation therapy for rectal cancer: executive summary of an ASTRO clinical practice guideline. Pract. Radiat. Oncol. 11, 13−25 (2021).
pubmed: 33097436 doi: 10.1016/j.prro.2020.08.004
Garcia-Aguilar, J. P. S. et al. Preliminary results of the organ preservation of rectal adenocarcinoma (OPRA) trial. J. Clin. Oncol. 38, 4008 (2020).
doi: 10.1200/JCO.2020.38.15_suppl.4008
Smith, J. J. et al. Organ Preservation in Rectal Adenocarcinoma: a phase II randomized controlled trial evaluating 3-year disease-free survival in patients with locally advanced rectal cancer treated with chemoradiation plus induction or consolidation chemotherapy, and total mesorectal excision or nonoperative management. BMC Cancer 15, 767 (2015).
pubmed: 26497495 pmcid: 4619249 doi: 10.1186/s12885-015-1632-z
Maas, M. et al. Assessment of clinical complete response after chemoradiation for rectal cancer with digital rectal examination, endoscopy, and MRI: selection for organ-saving treatment. Ann. Surg. Oncol. 22, 3873–3880 (2015).
pubmed: 26198074 pmcid: 4595525 doi: 10.1245/s10434-015-4687-9
Jorge, J. M. & Wexner, S. D. Etiology and management of fecal incontinence. Dis. Colon. Rectum 36, 77–97 (1993).
pubmed: 8416784 doi: 10.1007/BF02050307
Emmertsen, K. J. & Laurberg, S. Low anterior resection syndrome score: development and validation of a symptom-based scoring system for bowel dysfunction after low anterior resection for rectal cancer. Ann. Surg. 255, 922–928 (2012).
pubmed: 22504191 doi: 10.1097/SLA.0b013e31824f1c21
Temple, L. K. et al. The development of a validated instrument to evaluate bowel function after sphincter-preserving surgery for rectal cancer. Dis. Colon. Rectum 48, 1353–1365 (2005).
pubmed: 15868235 doi: 10.1007/s10350-004-0942-z
Vaizey, C. J., Carapeti, E., Cahill, J. A. & Kamm, M. A. Prospective comparison of faecal incontinence grading systems. Gut 44, 77–80 (1999).
pubmed: 9862829 pmcid: 1760067 doi: 10.1136/gut.44.1.77
Heald, R. J., Beets, G. & Carvalho, C. Report from a consensus meeting: response to chemoradiotherapy in rectal cancer — predictor of cure and a crucial new choice for the patient: on behalf of the Champalimaud 2014 Faculty for ‘Rectal cancer: when NOT to operate’. Colorectal Dis. 16, 334–337 (2014).
pubmed: 24725662 doi: 10.1111/codi.12627
Buyse, M. et al. Statistical evaluation of surrogate endpoints with examples from cancer clinical trials. Biomed. J. 58, 104–132 (2016).
Maas, M. et al. Long-term outcome in patients with a pathological complete response after chemoradiation for rectal cancer: a pooled analysis of individual patient data. Lancet Oncol. 11, 835–844 (2010).
pubmed: 20692872 doi: 10.1016/S1470-2045(10)70172-8
Chadi, S. A. et al. Factors affecting local regrowth after watch and wait for patients with a clinical complete response following chemoradiotherapy in rectal cancer (InterCoRe consortium): an individual participant data meta-analysis. Lancet Gastroenterol. Hepatol. 3, 825–836 (2018).
pubmed: 30318451 doi: 10.1016/S2468-1253(18)30301-7
Battersby, N. J. et al. A rectal cancer feasibility study with an embedded phase III trial design assessing magnetic resonance tumour regression grade (mrTRG) as a novel biomarker to stratify management by good and poor response to chemoradiotherapy (TRIGGER): study protocol for a randomised controlled trial. Trials 18, 394 (2017).
pubmed: 28851403 pmcid: 5576102 doi: 10.1186/s13063-017-2085-2
Saad, E. D., Paoletti, X., Burzykowski, T. & Buyse, M. Precision medicine needs randomized clinical trials. Nat. Rev. Clin. Oncol. 14, 317–323 (2017).
pubmed: 28169302 doi: 10.1038/nrclinonc.2017.8
van der Valk, M. J. M. et al. Importance of patient reported and clinical outcomes for patients with locally advanced rectal cancer and their treating physicians. Do clinicians know what patients want? Eur. J. Surg. Oncol. 46, 1634–1641 (2020).
pubmed: 32336626 doi: 10.1016/j.ejso.2020.04.014
van der Sande, M. E. et al. Impact of radiotherapy on anorectal function in patients with rectal cancer following a watch and wait programme. Radiother. Oncol. 132, 79–84 (2019).
pubmed: 30825973 doi: 10.1016/j.radonc.2018.11.017
Dizdarevic, E. et al. Long-term patient-reported outcomes after high-dose chemoradiation therapy for nonsurgical management of distal rectal cancer. Int. J. Radiat. Oncol. Biol. Phys. 106, 556–563 (2020).
pubmed: 31707122 doi: 10.1016/j.ijrobp.2019.10.046
Peltrini, R., Sacco, M., Luglio, G. & Bucci, L. Local excision following chemoradiotherapy in T2-T3 rectal cancer: current status and critical appraisal. Updates Surg. 72, 29–37 (2020).
pubmed: 31621033 doi: 10.1007/s13304-019-00689-2
Smith, F. M. et al. Local excision techniques for rectal cancer after neoadjuvant chemoradiotherapy: what are we doing? Dis. Colon. Rectum 60, 228–239 (2017).
pubmed: 28059920 doi: 10.1097/DCR.0000000000000749
Arezzo, A. et al. Individual participant data pooled-analysis of risk factors for recurrence after neoadjuvant radiotherapy and transanal local excision of rectal cancer: the PARTTLE study. Tech. Coloproctol. 23, 831–842 (2019).
pubmed: 31388861 doi: 10.1007/s10151-019-02049-z
Sloothaak, D. A. et al. Optimal time interval between neoadjuvant chemoradiotherapy and surgery for rectal cancer. Br. J. Surg. 100, 933–939 (2013).
pubmed: 23536485 doi: 10.1002/bjs.9112
Garcia-Aguilar, J. et al. Effect of adding mFOLFOX6 after neoadjuvant chemoradiation in locally advanced rectal cancer: a multicentre, phase 2 trial. Lancet Oncol. 16, 957–966 (2015).
pubmed: 26187751 pmcid: 4670237 doi: 10.1016/S1470-2045(15)00004-2
Fokas, E. et al. Randomized phase II trial of chemoradiotherapy plus induction or consolidation chemotherapy as total neoadjuvant therapy for locally advanced rectal cancer: CAO/ARO/AIO-12. J. Clin. Oncol. 37, 3212−3222 (2019).
pubmed: 31150315 doi: 10.1200/JCO.19.00308
Glynne-Jones, R. et al. Best time to assess complete clinical response after chemoradiotherapy in squamous cell carcinoma of the anus (ACT II): a post-hoc analysis of randomised controlled phase 3 trial. Lancet Oncol. 18, 347–356 (2017).
pubmed: 28209296 pmcid: 5337624 doi: 10.1016/S1470-2045(17)30071-2
Bahadoer, R. R. et al. Short-course radiotherapy followed by chemotherapy before total mesorectal excision (TME) versus preoperative chemoradiotherapy, TME, and optional adjuvant chemotherapy in locally advanced rectal cancer (RAPIDO): a randomised, open-label, phase 3 trial. Lancet Oncol. 22, 29−42 (2020).
Conroy, T. et al. Neoadjuvant chemotherapy with FOLFIRINOX and preoperative chemoradiotherapy for patients with locally advanced rectal cancer (UNICANCER-PRODIGE 23): a multicentre, randomised, open-label, phase 3 trial. Lancet Oncol. 22, 702−715 (2021).
pubmed: 33862000 doi: 10.1016/S1470-2045(21)00079-6
Bahadoer, R. R. et al. Short-course radiotherapy followed by chemotherapy before total mesorectal excision (TME) versus preoperative chemoradiotherapy, TME, and optional adjuvant chemotherapy in locally advanced rectal cancer (RAPIDO): a randomised, open-label, phase 3 trial. Lancet Oncol. 22, 29–42 (2021).
pubmed: 33301740 doi: 10.1016/S1470-2045(20)30555-6
Sun, W. et al. Controversies in rectal cancer treatment and management. Am. Soc. Clin. Oncol. Educ. Book. 40, 136–146 (2020).
doi: 10.1200/EDBK_279871
Duldulao, M. P. et al. Distribution of residual cancer cells in the bowel wall after neoadjuvant chemoradiation in patients with rectal cancer. Dis. Colon Rectum 56, 142–149 (2013).
pubmed: 23303141 pmcid: 4674069 doi: 10.1097/DCR.0b013e31827541e2
Kim, J. H., Beets, G. L., Kim, M. J., Kessels, A. G. & Beets-Tan, R. G. High-resolution MR imaging for nodal staging in rectal cancer: are there any criteria in addition to the size? Eur. J. Radiol. 52, 78–83 (2004).
pubmed: 15380850 doi: 10.1016/j.ejrad.2003.12.005
Heijnen, L. A. et al. Nodal staging in rectal cancer: why is restaging after chemoradiation more accurate than primary nodal staging? Int. J. Colorectal Dis. 31, 1157–1162 (2016).
pubmed: 27055660 pmcid: 4867151 doi: 10.1007/s00384-016-2576-8
van Heeswijk, M. M. et al. DWI for assessment of rectal cancer nodes after chemoradiotherapy: is the absence of nodes at DWI proof of a negative nodal status? Am. J. Roentgenol. 208, W79–W84 (2017).
doi: 10.2214/AJR.16.17117
Perez, R. O. et al. Lymph node size in rectal cancer following neoadjuvant chemoradiation — can we rely on radiologic nodal staging after chemoradiation? Dis. Colon Rectum 52, 1278–1284 (2009).
pubmed: 19571705 doi: 10.1007/DCR.0b013e3181a0af4b
Garcia-Aguilar, J. et al. Organ preservation for clinical T2N0 distal rectal cancer using neoadjuvant chemoradiotherapy and local excision (ACOSOG Z6041): results of an open-label, single-arm, multi-institutional, phase 2 trial. Lancet Oncol. 16, 1537–1546 (2015).
pubmed: 26474521 pmcid: 4984260 doi: 10.1016/S1470-2045(15)00215-6
Rupinski, M. et al. Watch and wait policy after preoperative radiotherapy for rectal cancer; management of residual lesions that appear clinically benign. Eur. J. Surg. Oncol. 42, 288–296 (2016).
pubmed: 26506863 doi: 10.1016/j.ejso.2015.09.022
Habr-Gama, A. et al. Management of adenomas within the area of rectal cancer that develop complete pathological response. Int. J. Colorectal Dis. 30, 1285–1287 (2015).
pubmed: 26243467 doi: 10.1007/s00384-015-2326-3
Rijkmans, E. C. et al. Predictive factors for response and toxicity after brachytherapy for rectal cancer; results from the HERBERT study. Radiother. Oncol. 133, 176–182 (2019).
pubmed: 30935576 doi: 10.1016/j.radonc.2019.01.034
van Stiphout, R. G. et al. Nomogram predicting response after chemoradiotherapy in rectal cancer using sequential PETCT imaging: a multicentric prospective study with external validation. Radiother. Oncol. 113, 215–222 (2014).
pubmed: 25466368 doi: 10.1016/j.radonc.2014.11.002
Das, P. et al. Predictors of tumor response and downstaging in patients who receive preoperative chemoradiation for rectal cancer. Cancer 109, 1750–1755 (2007).
pubmed: 17387743 doi: 10.1002/cncr.22625
Junginger, T. et al. Long-term results of transanal endoscopic microsurgery after endoscopic polypectomy of malignant rectal adenoma. Tech. Coloproctol. 21, 225–232 (2017).
pubmed: 28251355 doi: 10.1007/s10151-017-1595-y
Serra-Aracil, X. et al. Transanal endoscopic surgery is effective and safe after endoscopic polypectomy of potentially malignant rectal polyps with questionable margins. Colorectal Dis. 20, 789–796 (2018).
pubmed: 29577555 doi: 10.1111/codi.14108
Serra-Aracil, X. et al. Transanal endoscopic surgery with total wall excision is required with rectal adenomas due to the high frequency of adenocarcinoma. Dis. Colon Rectum 57, 823–829 (2014).
pubmed: 24901682 doi: 10.1097/DCR.0000000000000139
Jones, H. J. S., Al-Najami, I., Baatrup, G. & Cunningham, C. Local excision after polypectomy for rectal polyp cancer: when is it worthwhile? Colorectal Dis. 23, 868–874 (2021).
pubmed: 33306264 doi: 10.1111/codi.15480
Jones, H. J. S. & Cunningham, C. Adjuvant radiotherapy after local excision of rectal cancer. Acta Oncol. 58, S60–S64 (2019).
pubmed: 30789086 doi: 10.1080/0284186X.2019.1578895
Gerard, J. P. et al. Planned organ preservation for early T2-3 rectal adenocarcinoma: a French, multicentre study. Eur. J. Cancer 108, 1–16 (2019).
pubmed: 30580125 doi: 10.1016/j.ejca.2018.11.022
Patel, U. B., Blomqvist, L., Chau, I., Nicholls, J. & Brown, G. Session 3: beyond TME and radiotherapy MRI evaluation of rectal cancer treatment response. Colorectal Dis. 20, 76–81 (2018).
pubmed: 29878685 doi: 10.1111/codi.14084
Lambregts, D. M. J. et al. Long-term imaging characteristics of clinical complete responders during watch-and-wait for rectal cancer — an evaluation of over 1500 MRIs. Eur. Radiol. 30, 272–280 (2020).
pubmed: 31428827 doi: 10.1007/s00330-019-06396-1
Lambregts, D. M. J. et al. A pattern-based approach combining tumor morphology on MRI with distinct signal patterns on diffusion-weighted imaging to assess response of rectal tumors after chemoradiotherapy. Dis. Colon Rectum 61, 328–337 (2018).
pubmed: 29369900 doi: 10.1097/DCR.0000000000000915
van Griethuysen, J. J. M. et al. Radiomics performs comparable to morphologic assessment by expert radiologists for prediction of response to neoadjuvant chemoradiotherapy on baseline staging MRI in rectal cancer. Abdom. Radiol. 45, 632–643 (2020).
doi: 10.1007/s00261-019-02321-8
Socha, J., Kepka, L., Michalski, W., Paciorek, K. & Bujko, K. The risk of distant metastases in rectal cancer managed by a watch-and-wait strategy — a systematic review and meta-analysis. Radiother. Oncol. 144, 1–6 (2020).
pubmed: 31710938 doi: 10.1016/j.radonc.2019.10.009
Fernandez, L. M. et al. Conditional recurrence-free survival of clinical complete responders managed by watch and wait after neoadjuvant chemoradiotherapy for rectal cancer in the International Watch & Wait Database: a retrospective, international, multicentre registry study. Lancet Oncol. 22, 43–50 (2021).
pubmed: 33316218 doi: 10.1016/S1470-2045(20)30557-X
Hupkens, B. J. P. et al. Quality of life in rectal cancer patients after chemoradiation: watch-and-wait policy versus standard resection — a matched-controlled study. Dis. Colon Rectum 60, 1032–1040 (2017).
pubmed: 28891846 doi: 10.1097/DCR.0000000000000862
Fish, R. et al. A core outcome set for clinical trials of chemoradiotherapy interventions for anal cancer (CORMAC): a patient and health-care professional consensus. Lancet Gastroenterol. Hepatol. 3, 865–873 (2018).
pubmed: 30507470 doi: 10.1016/S2468-1253(18)30264-4
Hui, D. et al. Referral criteria for outpatient specialty palliative cancer care: an international consensus. Lancet Oncol. 17, e552–e559 (2016).
pubmed: 27924753 doi: 10.1016/S1470-2045(16)30577-0
Hasson, F., Keeney, S. & McKenna, H. Research guidelines for the Delphi survey technique. J. Adv. Nurs. 32, 1008–1015 (2000).
pubmed: 11095242
Kirkham, J. J. et al. Core outcome Set-STandards for development: the COS-STAD recommendations. PLoS Med. 14, e1002447 (2017).
pubmed: 29145404 pmcid: 5689835 doi: 10.1371/journal.pmed.1002447
Kunneman, M., Pieterse, A. H., Stiggelbout, A. M. & Marijnen, C. A. Which benefits and harms of preoperative radiotherapy should be addressed? A Delphi consensus study among rectal cancer patients and radiation oncologists. Radiother. Oncol. 114, 212–217 (2015).
pubmed: 25497119 doi: 10.1016/j.radonc.2014.11.034
Gani, C. et al. Organ preservation in rectal cancer: the patients’ perspective. Front. Oncol. 9, 318 (2019).
pubmed: 31134146 pmcid: 6524150 doi: 10.3389/fonc.2019.00318

Auteurs

Emmanouil Fokas (E)

Department of Radiotherapy of Oncology, University of Frankfurt, Frankfurt, Germany. emmanouil.fokas@kgu.de.
German Cancer Research Center (DKFZ), Heidelberg, Germany. emmanouil.fokas@kgu.de.
German Cancer Consortium (DKTK), Frankfurt, Germany. emmanouil.fokas@kgu.de.
Frankfurt Cancer Institute (FCI), Frankfurt, Germany. emmanouil.fokas@kgu.de.
ORCID: 0000-0003-1601-6165

Ane Appelt (A)

Leeds Institute of Medical Research at St James's, University of Leeds, Leeds, UK.
ORCID: 0000-0003-2792-9218

Robert Glynne-Jones (R)

Department of Radiotherapy, Mount Vernon Centre for Cancer Treatment, Northwood, UK.
ORCID: 0000-0002-6742-222X

Geerard Beets (G)

GROW School for Oncology and Developmental Biology, Maastricht University, Maastricht, Netherlands.
Department of Surgery, Netherlands Cancer Institute Amsterdam, Amsterdam, Netherlands.

Rodrigo Perez (R)

Department of Surgery, Angelita & Joaquim Institute, São Paulo, Brazil.

Julio Garcia-Aguilar (J)

Colorectal Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, NY, USA.

Eric Rullier (E)

Department of Colorectal Surgery, Haut-Lévèque Hospital, Centre Hospitalier Universitaire (CHU) Bordeaux, Bordeaux, France.

J Joshua Smith (JJ)

Colorectal Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, NY, USA.
ORCID: 0000-0003-2538-5456

Corrie Marijnen (C)

Department of Radiation Oncology, Netherlands Cancer Institute, Amsterdam, Netherlands.

Femke P Peters (FP)

Department of Radiation Oncology, Netherlands Cancer Institute, Amsterdam, Netherlands.
ORCID: 0000-0001-9085-447X

Maxine van der Valk (M)

Department of Surgery, Netherlands Cancer Institute Amsterdam, Amsterdam, Netherlands.

Regina Beets-Tan (R)

GROW School for Oncology and Developmental Biology, Maastricht University, Maastricht, Netherlands.
Department of Radiology, Netherlands Cancer Institute, Amsterdam, Netherlands.

Arthur S Myint (AS)

The Clatterbridge Cancer Centre, Royal Liverpool University Hospital, Liverpool, UK.

Jean-Pierre Gerard (JP)

Service de Radiothérapie, Centre Antoine-Lacassagne, Nice, France.

Simon P Bach (SP)

Academic Department of Surgery, University of Birmingham, Birmingham, UK.
ORCID: 0000-0001-8412-7241

Michael Ghadimi (M)

Department of General, Visceral, and Paediatric Surgery, University Medical Center, Göttingen, Germany.

Ralf D Hofheinz (RD)

Department of Medical Oncology, University Hospital Mannheim, University of Heidelberg, Heidelberg, Germany.

Krzysztof Bujko (K)

Department of Radiotherapy, Maria Sklodowska-Curie National Research Institute of Oncology, Warsaw, Poland.

Cihan Gani (C)

Department of Radiation Oncology, University Hospital and Medical Faculty Tübingen, Eberhard Karls University Tübingen, Tübingen, Germany.
German Cancer Research Center (DKFZ) Heidelberg and German Consortium for Translational Cancer Research (DKTK) Partner Site Tübingen, Tübingen, Germany.

Karin Haustermans (K)

Department of Radiation Oncology, University Hospital Leuven, Leuven, Belgium.

Bruce D Minsky (BD)

Department of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX, USA.

Ethan Ludmir (E)

Department of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX, USA.
ORCID: 0000-0002-5472-5344

Nicholas P West (NP)

Division of Pathology and Data Analytics, Leeds Institute of Medical Research at St. James's, School of Medicine, University of Leeds, Leeds, UK.

Maria A Gambacorta (MA)

Department of Radiation Oncology and Medical Oncology, Fondazione Policlinico Universitario A. Gemelli Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS), Università Cattolica del Sacro Cuore, Rome, Italy.

Vincenzo Valentini (V)

Department of Radiation Oncology and Medical Oncology, Fondazione Policlinico Universitario A. Gemelli Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS), Università Cattolica del Sacro Cuore, Rome, Italy.

Marc Buyse (M)

Interuniversity Institute for Biostatistics and Statistical Bioinformatics, Hasselt University, Diepenbeek, Belgium.
International Drug Development Institute, San Francisco, CA, USA.

Andrew G Renehan (AG)

Division of Cancer Sciences, School of Medical Sciences, Faculty of Biology, Medicine and Health, Manchester Academic Health Science Centre, University of Manchester, Manchester, UK.
Colorectal and Peritoneal Oncology Centre, Christie NHS Foundation Trust, Manchester, UK.

Alexandra Gilbert (A)

Leeds Institute of Medical Research at St James's, University of Leeds, Leeds, UK.

David Sebag-Montefiore (D)

Leeds Institute of Medical Research at St James's, University of Leeds, Leeds, UK.

Claus Rödel (C)

Department of Radiotherapy of Oncology, University of Frankfurt, Frankfurt, Germany.
German Cancer Research Center (DKFZ), Heidelberg, Germany.
German Cancer Consortium (DKTK), Frankfurt, Germany.
Frankfurt Cancer Institute (FCI), Frankfurt, Germany.

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Classifications MeSH

questionsmedicales.fr › Thérapeutique › Radiothérapie › Chimioradiothérapie › International consensus recommendations on key...
questionsmedicales.fr › Phénomènes psychologiques › Processus mentaux › Pensée (activité mentale) › Prise de décision › Consensus › International consensus recommendations on key...
questionsmedicales.fr › Sciences de l'information › Analyse des systèmes › Méthode Delphi › International consensus recommendations on key...
questionsmedicales.fr › Eucaryotes › Animaux › Chordés › Vertébrés › Mammifères › Eutheria › Primates › Haplorhini › Catarrhini › Hominidae › Humains › International consensus recommendations on key...
questionsmedicales.fr › Techniques d'investigation › Conservation biologique › Conservation de tissu › Conservation d'organe › International consensus recommendations on key...
questionsmedicales.fr › Maladies de l'appareil digestif › Maladies gastro-intestinales › Maladies intestinales › Maladies du rectum › Tumeurs colorectales › Tumeurs du rectum › International consensus recommendations on key...