371
edits
OPRA: Difference between revisions
Jump to navigation
Jump to search
no edit summary
Edadams916 (talk | contribs) |
Edadams916 (talk | contribs) No edit summary |
||
| Line 29: | Line 29: | ||
==Bottom Line== | ==Bottom Line== | ||
Organ preservation was achieved in | Organ preservation was achieved in 46% of patients with locally advanced rectal adenocarcinoma using TNT and a selective WW approach without compromising disease-free survival compared to historic controls. Treatment initiation with chemoradiotherapy followed by consolidation chemotherapy (CRT-CNCT) demonstrated higher organ preservation rates than induction chemotherapy followed by chemoradiotherapy (INCT-CRT). | ||
==Major Points== | ==Major Points== | ||
* need to make this more paragraph form - EA | |||
* The OPRA trial evaluated the efficacy of organ preservation in rectal cancer using TNT and selective WW or total mesorectal excision (TME) based on tumor response. | * The OPRA trial evaluated the efficacy of organ preservation in rectal cancer using TNT and selective WW or total mesorectal excision (TME) based on tumor response. | ||
* 324 patients with stage II-III rectal adenocarcinoma were randomized to INCT-CRT or CRT-CNCT and treated with TNT (systemic chemotherapy and chemoradiotherapy). | * 324 patients with stage II-III rectal adenocarcinoma were randomized to INCT-CRT or CRT-CNCT and treated with TNT (systemic chemotherapy and chemoradiotherapy). | ||
| Line 40: | Line 42: | ||
==Guidelines== | ==Guidelines== | ||
* | * NCCN guidelines Version 4.2024: "In those patients who achieve a complete clinical response with no evidence of residual disease on digital rectal examination (DRE), rectal MRI, and direct endoscopic | ||
* | evaluation, a “watch and wait,” nonoperative (chemotherapy and/or RT) management approach may be considered in centers with experienced multidisciplinary teams. | ||
The degree to which risk of local and/or distant failure may be increased relative to standard surgical resection has not yet been adequately characterized. Decisions for | |||
nonoperative management (NOM) should involve a careful discussion with the patient of their risk tolerance" | |||
* NCCN guidelines for watch and wait protocol: | |||
** DRE and proctoscopy every 3-4 months for 2 years, then every 6 months/3 years | |||
** MRI rectum every 6 months for at least 3 years | |||
* 2023 ASCRS Clinical Practice Guidelines Managment of Rectal Cancer Supplement | |||
**Following neoadjuvant therapy, patients should be assessed to determine response to treatment at 8-12 weeks | |||
https://fascrs.org/ascrs/media/files/2023-Rectal-Cancer-Supplement.pdf | |||
==Design== | ==Design== | ||