Three perspectives: the approach to neoadjuvant treatment of rectal cancer according to medical oncologists, radiation oncologists, and surgeons

Abstract

Background: Two treatment options considered for radiotherapy are short-course radiotherapy and immediate surgery, or chemoradiation with 5-Fluorouracil based chemotherapy and delayed surgery. Aim of the study: Evaluate the real-life treatment approaches of medical, radiation, and surgical oncologists, to neoadjuvant treatment of rectal cancers. Material and methods: An online survey was established via Google Forms. The survey was taken voluntarily by medical oncologists, radiation oncologists, surgical oncologists, and general surgeons. Results: Of those who participated, 183 were medical oncologists, 36 were radiotherapists, and 36 were surgeons. Most of the study population preferred long-course radiation therapy and chemotherapy (85%). Meanwhile, two-thirds of the participants preferred chemotherapy prior to operating. The most frequent chemotherapy cycles for the pre-operative setting were ‘three’ and ‘four-or-more’ (27.8% and 25.1%, respectively). Medical oncologists had a significantly higher tendency to offer chemotherapy between radiation therapy and surgery compared to the other groups. Optimal time of surgery was different between groups, but there was no difference among groups between surgery and the ‘watch & wait’ strategy. Neoadjuvant chemotherapy regimens were significantly different between groups. Conclusions: We found that the new pre-operative chemotherapy regimen with short-course radiotherapy was slowly adopted into current practice. Also, medical oncologists tended to prefer pre-operative chemotherapy in comparison to the other groups.