Patterns of care in medical oncology
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Patterns of Care in Medical Oncology. Neoadjuvant and Adjuvant Treatment of Rectal Cancer. To approximately how many patients with rectal cancer have you administered neoadjuvant chemoradiation therapy in the past year?.

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Patterns of Care in Medical Oncology

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Patterns of care in medical oncology

Patterns of Care in Medical Oncology

Neoadjuvant and Adjuvant Treatment of Rectal Cancer


Patterns of care in medical oncology

To approximately how many patients with rectal cancer have you administered neoadjuvant chemoradiation therapy in the past year?


Patterns of care in medical oncology

Preoperative radiation therapy combined with capecitabine and oxaliplatin versus radiation therapy combined with 5-FU and oxaliplatin for patients with resectable rectal cancer

Protocol ID: NSABP-R-04, Target Accrual: 1,606 (Open)

5-FU + radiation therapy

Continuous infusion 5-FU 225 mg/m2 per day for 5 days per week on days of planned radiation

therapy (RT*)

R

5-FU + radiation therapy + oxaliplatin

Same as arm 1, with oxaliplatin 50 mg/m2 weekly x 5 during RT*

*4,500 cGy in 25 fractions over five weeks with a 540-cGy boost in three fractions for nonfixed tumors or a 1,080-cGy boost in six fractions for fixed tumors

Source: NSABP-R-04 Protocol, November 24, 2008.


Patterns of care in medical oncology

Preoperative radiation therapy combined with capecitabine and oxaliplatin versus radiation therapy combined with 5-FU and oxaliplatin for patients with resectable rectal cancer

Protocol ID: NSABP-R-04, Target Accrual: 1,606 (Open)

Capecitabine + radiation therapy

Capecitabine 825 mg/m2 BID 5 days per week on days of planned RT*

R

Capecitabine + radiation therapy + oxaliplatin

Same as arm 3, with oxaliplatin 50 mg/m2 weekly x 5 during RT*

*4,500 cGy in 25 fractions over five weeks with a 540-cGy boost in three fractions for nonfixed tumors or a 1,080-cGy boost in six fractions for fixed tumors

Source: NSABP-R-04 Protocol, November 24, 2008.


Patterns of care in medical oncology

When administering a fluoropyrimidine during radiation therapy, which regimen do you generally recommend?


Patterns of care in medical oncology

Patients who receive 5-FU/LV with radiation therapy for neoadjuvant treatment of rectal cancer and have positive nodes in the resection specimen postoperatively should generally receive which of the following regimens?


Patterns of care in medical oncology

Have you used oxaliplatin off protocol as part of neoadjuvant chemoradiation therapy for rectal cancer?

CI n = 12; PO n = 22


Patterns of care in medical oncology

Have you used bevacizumab off protocol as part of neoadjuvant chemoradiation therapy for rectal cancer?

CI n = 0; PO n = 7


Patterns of care in medical oncology

For the patient with rectal cancer at the anal verge who achieves a clinical complete response with a negative biopsy of the primary site after neoadjuvant chemoradiation therapy, surveillance with delayed resection at recurrence is acceptable.


Case 6 rectal cancer

Case 6: Rectal Cancer

  • A 65-year-old man in average health

  • T3N0 rectal cancer by endoscopic ultrasound

  • Lesion is 8 centimeters from the anal verge


Case 7 rectal cancer

Case 7: Rectal Cancer

  • A 65-year-old man in average health

  • T3N1 rectal cancer (2 enlarged lymph nodes on endoscopic ultrasound)

  • Lesion is 8 centimeters from the anal verge


Patterns of care in medical oncology

Case 8: Rectal Cancer After Neoadjuvant Treatment and with Complete Pathologic Response Evident on Resection, Including Absence of Residual Nodal Disease

  • Man in average health

  • T3N1 rectal cancer (2 enlarged lymph nodes on endoscopic ultrasound)

  • Lesion is 8 centimeters from the anal verge

  • Undergoes neoadjuvant chemoradiation therapy with XELOX/CAPOX

  • Complete pathologic response evident on resection


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