7. Improving quality of care of colorectal cancer in Europe

Abstract

improvement in medical technology and have access to an ever increasing amount of data on cancer. In the past two decades a series of multi-institution clinical trials have done much to define the role of multi-modality treatment in the management of rectal adenocarcinoma. These trials have addressed a number of questions about sequencing of modalities, integration of radiation and chemotherapy, and radiation dose fractionation in the adjunctive management of patients undergoing extirpative surgery Although the findings of large randomized trials have addressed important questions, there remain patient care issues that cannot be addressed by subgroup analyses of existing trials. It is particularly important to develop measures that will allow the treating physician to deliver more tailored choices–as the oncology profession moves into the era of individualized medicine. Consensus guidelines try to help clinicians but very often large areas of controversies are still in place Recent publication on 2795 individual data of patients accrued in preoperative radiochemotherapy randomized trails provided nomograms to predict local recurrence, distant metastases and survival for locally advanced rectal cancer patients treated with long-course CRT followed by surgery These prediction models are structured to allow the integration of new data from molecular imaging and biology, which will help to improve the reliability of their prediction. They also provide an objective subgroup identification to address clinical trial for more homogenous groups of patients.