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Clinical Guideline | Open Access

Radiotherapy guidelines for rectal cancer in China (2020 Edition)

Shixin Liu1,2,3 ( )Jing Jin1,2,3( )
Radiation Oncology Society of Chinese Medical Doctor Association, China
Radiation Oncology Society of Chinese Medical Association, China
Cancer Radiotherapy Committee of Anti-cancer Association of China, China
Show Author Information

Abstract

Rectal cancer is one of the most common malignant tumors. In China, rectal cancer has been the third most frequently diagnosed cancer and the fifth leading cause of cancer death, with changes of residents’ lifestyle factors and diets. The best treatment for rectal cancer depends on many factors. Multidisciplinary Treatment has become the basis for improving the therapeutic effect, in which radiology is increasingly necessary for treating patients with rectal cancer. For patients who have extensive, fixed, bulky tumors or obvious nodal disease, radiotherapy and chemotherapy combined with surgery has emerged as the standard of care. For patients with metastatic disease, the reasonable combination of local and systemic therapy might be an alternative. Improvements in imaging, pathological diagnosis and radiation techniques provide a solid foundation for promoting the level of clinical practice in rectal cancer. High-quality magnetic resonance imaging distinguishing risk stratification, molecular markers predicting therapeutic effect and prognosis, magnetic resonance imaging in delineating target volumes drawn, intensity-modulated radiation therapy, and image-guides radiation therapy for precision treatment delivery are all being widely applied in multiple centers. Furthermore, as the role of targeted therapy and immune therapy has become increasingly prominent, the attempt of combined radiotherapy is also ongoing. In view of the characteristics and current situation of diagnosis and treatment of rectal cancer in China, the guidelines will present the basis and reference for combined treatment and standardized treatments. Meanwhile, there may be continuous new advances in clinical practice, and that will be a new basis to update the guidelines, directly benefiting all rectal cancer patients and facilitating discipline developments.

References

1

National Health Commission of the People's Republic of China. Chinese code for diagnosis and treatment of colorectal cancer (2020 edition). Chin J Surg, 2020; 58(8): 561–585.

2

Lynch HT, Smyrk TC, Watson P, et al. Genetics, natural history, tumor spectrum, and pathology of hereditary nonpolyposis colorectal cancer: an updated review. Gastroenterology. 1993; 104(5): 1535–1549.

3

Ponz de Leon M, Sassatelli R, Benatti P, et al. Identification of hereditary nonpolyposis colorectal cancer in the general population. The 6-year experience of a population-based registry. Cancer. 1993; 71(11): 3493–3501.

4

Yurgelun MB, Kulke MH, Fuchs CS, et al. Cancer susceptibility gene mutations in individuals with colorectal cancer. J Clin Oncol. 2017; 35(10): 1086-1095.

5

Liu Z, Zhang Y, Niu Y, et al. A systematic review and meta-analysis of diagnostic and prognostic serum biomarkers of colorectal cancer. PLoS One. 2014; 9(8):e103910.

6

O'Connell E, Galvin R, McNamara DA, et al. The utility of preoperative radiological evaluation of early rectal neoplasia: a systematic review and meta-analysis. Colorectal Dis. 2020; 22(9): 1076–1084.

7

Pappalardo G, Chiaretti M. Early rectal cancer: a choice between local excision and transabdominal resection. A review of the literature and current guidelines. Ann Ital Chir. 2017; 88: 183-189.

8

Glynne-Jones R, Wyrwicz L, Tiret E, et al. Rectal cancer: ESMO clinical practice guidelines for diagnosis, treatment and follow-up. Ann Oncol. 2017; 28(suppl_4): iv22–iv40.

9

Choi SH, Kim SY, Park SH, et al. Diagnostic performance of CT, gadoxetate disodium-enhanced MRI, and PET/CT for the diagnosis of colorectal liver metastasis: systematic review and meta-analysis. J Magn Reson Imaging. 2018; 47(5): 1237–1250.

10

Daza JF, Solis NM, Parpia S, et al. A meta-analysis exploring the role of PET and PET-CT in the management of potentially resectable colorectal cancer liver metastases. Eur J Surg Oncol. 2019; 45(8): 1341–1348.

11

Hashiguchi Y, Muro K, Saito Y, et al. Japanese society for cancer of the colon and rectum (JSCCR) guidelines 2019 for the treatment of colorectal cancer. Int J Clin Oncol. 2020; 25(1): 1–42.

12

DʼSouza N, de Neree Tot Babberich MPM, d'Hoore A, et al. Definition of the rectum: an international, expert-based Delphi consensus. Ann Surg. 2019; 270(6): 955-959.

13

Diagnosis and Treatment Guidelines for Colorectal Cancer Working Group (CSOCOC. Chinese society of clinical oncology (CSCO) diagnosis and treatment guidelines for colorectal cancer 2018 (English version). Chin J Cancer Res. 2019; 31(1): 117–134.

14

Beets-Tan RGH, Lambregts DMJ, Maas M, et al. Magnetic resonance imaging for clinical management of rectal cancer: updated recommendations from the 2016 European society of gastrointestinal and abdominal radiology (ESGAR) consensus meeting. Eur Radiol. 2018; 28(4): 1465–1475.

15

Battersby NJ, How P, Moran B, et al. Prospective validation of a low rectal cancer magnetic resonance imaging staging system and development of a local recurrence risk stratification model: the MERCURY Ⅱ study. Ann Surg. 2016; 263(4): 751–760.

16

Petrelli F, Sgroi G, Sarti E, et al. Increasing the interval between neoadjuvant chemoradiotherapy and surgery in rectal cancer: a meta-analysis of published studies. Ann Surg. 2016; 263(3): 458–464.

17

Lefevre JH, Mineur L, Kotti S, et al. Effect of interval (7 or 11 weeks) between neoadjuvant radiochemotherapy and surgery on complete pathologic response in rectal cancer: a multicenter, randomized, controlled trial (GRECCAR-6). J Clin Oncol. 2016; 34(31): 3773–3780.

18

Seo N, Kim H, Cho MS, et al. Response assessment with MRI after chemoradiotherapy in rectal cancer: current evidences. Kor J Radiol. 2019; 20(7): 1003–1018.

19

Sclafani F, Brown G, Cunningham D, et al. Comparison between MRI and pathology in the assessment of tumor regression grade in rectal cancer. Br J Cancer. 2017; 117(10): 1478–1485.

20

Van der Valk MJM, Hilling DE, Bastiaannet E, 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. 2018; 391(10139): 2537–2545.

21

Nagtegaal ID, Odze RD, Klimstra D, et al. The 2019 WHO classification of tumors of the digestive system. Histopathology. 2020; 76(2): 182–188.

22

Sauer R, Becker H, Hohenberger W, et al. Preoperative versus postoperative chemoradiotherapy for rectal cancer. N Engl J Med. 2004; 351(17): 1731–1740.

23

Keller DS, Berho M, Perez RO, et al. The multidisciplinary management of rectal cancer. Nat Rev Gastroenterol Hepatol. 2020; 17(7): 414–429.

24

Afshari K, Chabok A, Naredi P, et al. Prognostic factors for survival in stage Ⅳ rectal cancer: a Swedish nationwide case-control study. Surg Oncol. 2019; 107(5): 102–106.

25

Kok END, Havenga K, Tanis PJ, et al. Multicentre study of short-course radiotherapy, systemic therapy and resection/ablation for stage Ⅳ rectal cancer. Br J Surg. 2020; 107(5): 537–545.

26

Detering R, Karthaus EG, Borstlap WAA, et al. Treatment and survival of locally recurrent rectal cancer: a cross-sectional population study 15 years after the Dutch TME trial. Eur J Surg Oncol. 2019; 45(11): 2059–2069.

27

Hagemans JAW, van Rees JM, Alberda WJ, et al. Locally recurrent rectal cancer; long-term outcome of curative surgical and non-surgical treatment of 447 consecutive patients in a tertiary referral centre. Eur J Surg Oncol. 2020; 46(3): 448–454.

28
NCCN clinical practice guidelines in oncology: rectal cancer, version 1. 2020 [EB/OL]. [2021-04-28]. http://www.nccn.org/
29

Rödel C, Graeven U, Fietkau R, et al. Oxaliplatin added to fluorouracil-based preoperative chemoradiotherapy and postoperative chemotherapy of locally advanced rectal cancer (the German CAO/ARO/AIO-04 study): final results of the multicentre, open-label, randomised, phase 3 trial. Lancet Oncol. 2015; 16(8): 979–989.

30

Hofheinz RD, Wenz F, Post S, et al. Chemoradiotherapy with capecitabine versus fluorouracil for locally advanced rectal cancer: a randomised, multicentre, non-inferiority, phase 3 trial. Lancet Oncol. 2012; 13(6): 579-588.

31

Liu WY, Jin J, Tang Y, et al. Safety and efficacy of preoperative chemoradiotherapy in fit older patients with intermediate or locally advanced rectal cancer evaluated by comprehensive geriatric assessment: a planned interim analysis of a multicenter, phase Ⅱ trial. J Geriatr Oncol. 2021; 12(4): 572–577.

32

O'Connell MJ, Colangelo LH, Beart RW, et al. Capecitabine and oxaliplatin in the preoperative multimodality treatment of rectal cancer: surgical end points from national surgical adjuvant breast and bowel project trial R-04. J Clin Oncol. 2014; 32(18): 1927–1934.

33

Schmoll HJ, Stein A, Van Cutsem E, et al. Pre-and postoperative capecitabine without or with oxaliplatin in locally advanced rectal cancer: PETACC 6 trial by EORTC GITCG and ROG, AIO, AGITG, BGDO, and FFCD. J Clin Oncol. 2021; 39(1): 17–29.

34

Nogué M, Salud A, Vicente P, et al. Addition of bevacizumab to XELOX induction therapy plus concomitant capecitabine-based chemoradiotherapy in magnetic resonance imaging-defined poorprognosis locally advanced rectal cancer: the AVACROSS study. Oncologist. 2011; 16(5): 614–620.

35

Sclafani F, Brown G, Cunningham D, et al. PAN-EX: a pooled analysis of two trials of neoadjuvant chemotherapy followed by chemoradiotherapy in MRI-defined, locally advanced rectal cancer. Ann Oncol. 2016; 27(8): 1557–1565.

36

Deng Y, Chi P, Lan P, et al. Neoadjuvant modified FOLFOX6 with or without radiation versus fluorouracil plus radiation for locally advanced rectal cancer: final results of the Chinese FOWARC trial. J Clin Oncol. 2019; 37(34): 3223–3233.

37

Ngan SY, Burmeister B, Fisher RJ, et al. Randomized trial of short-course radiotherapy versus long-course chemoradiation comparing rates of local recurrence in patients with T3 rectal cancer: trans-Tasman radiation oncology group trial 01.04. J Clin Oncol. 2012; 30(31): 3827–3833.

38

Nilsson PJ, van Etten B, Hospers GA, et al. Short-course radiotherapy followed by neo-adjuvant chemotherapy in locally advanced rectal cancer—the RAPIDO trial. BMC Cancer. 2013; 13: 279.

39

Cella L, Ciscognetti N, Martin G, et al. Preoperative radiation treatment for rectal cancer: comparison of target coverage and small bowel NTCP in conventional vs. 3D-conformal planning. Med Dosim. 2009; 34(1): 75–81.

40

Kim TH, Chie EK, Kim DY, et al. Comparison of the belly board device method and the distended bladder method for reducing irradiated small bowel volumes in preoperative radiotherapy of rectal cancer patients. Int J Radiat Oncol Biol Phys. 2005; 62(3): 769–775.

41

O'Neill BD, Salerno G, Thomas K, et al. MR vs CT imaging: low rectal cancer tumor delineation for three-dimensional conformal radiotherapy. Br J Radiol. 2009; 82(978): 509–513.

42

yuan Tang, et al. Target mapping consensus and Atlas of preoperative /postoperative conformal/intensity modulated radiotherapy for rectal cancer. Chin J Radiat Oncol. 2018; 27(3): 227–234.

43

Colorectal Cancer Collaborative Group. Adjuvant radiotherapy for rectal cancer: a systematic overview of 8507 patients from 22 randomised trials. Lancet. 2001; 358(9290): 1291–1304.

44

Sauer R, Fietkau R, Wittekind C, et al. Adjuvant vs. neoadjuvant radiochemotherapy for locally advanced rectal cancer: the German trial CAO/ARO/AIO-94. Colorectal Dis. 2003; 5(5): 406–415.

45

Gao YH, Lin JZ, An X, et al. Neoadjuvant sandwich treatment with oxaliplatin and capecitabine administered prior to, concurrently with, and following radiation therapy in locally advanced rectal cancer: a prospective phase 2 trial. Int J Radiat Oncol Biol Phys. 2014; 90(5): 1153–1160.

46

Cercek A, Roxburgh CSD, Strombom P, et al. Adoption of total neoadjuvant therapy for locally advanced rectal cancer. JAMA Oncol. 2018; 4(6):e180071.

47

Zaborowski A, Stakelum A, Winter DC. Systematic review of outcomes after total neoadjuvant therapy for locally advanced rectal cancer. Br J Surg. 2019; 106(8): 979–987.

48

Shu Zhang, Xiaohao Wang, Wei Xiao, Wei, et al. Clinical analysis of high dose radiotherapy combined with chemotherapy in the treatment of rectal cancer. J Pract Oncol. 2018; 33(2): 102–107.

49

Appelt AL, Pløen J, Harling H, et al. High-dose chemoradiotherapy and watchful waiting for distal rectal cancer: a prospective observational study. Lancet Oncol. 2015; 16(8): 919–927.

50

Dizdarevic E, Frøstrup Hansen T, Pløen J, 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. 2020; 106(3): 556–563.

51

Marks LB, Ten Haken RK, Martel MK. Guest editor's introduction to QUANTEC: a users guide. Int J Radiat Oncol Biol Phys. 2010; 76: S1–S2.

52

Jadon R, Higgins E, Hanna L, Evans M, Coles B, Staffurth J. A systematic review of dose-volume predictors and constraints for late bowel toxicity following pelvic radiotherapy. Radiat Oncol. 2019; 14(1): 57.

53

McCormack S, Diffey J, Andrew Morgan A. The effect of gantry angle on megavoltage photon beam attenuation by a carbon fiber couch insert. Med Phys. 2005; 32(2): 483–487.

54

Kanai T, Furuichi W, Mori S. Evaluation of patient positional reproducibility on the treatment couch and its impact on dose distribution using rotating gantry system in scanned carbon-ion beam therapy. Phys Med. 2019; 57: 160–168.

55

Holyoake DLP, Partridge M, Hawkins MA. Systematic review and meta-analysis of small bowel dose-volume and acute toxicity in conventionally-fractionated rectal cancer radiotherapy. Radiother Oncol. 2019; 138: 38–44.

56

Vieillot S, Azria D, Lemanski C, et al. Plan comparison of volumetric-modulated arc therapy (RapidArc) and conventional intensity-modulated radiation therapy (IMRT) in anal canal cancer. Radiat Oncol. 2010; 5: 92.

57

Appelt AL, Sebag-Montefiore D. Technological advances in radiotherapy of rectal cancer: opportunities and challenges. Curr Opin Oncol. 2016; 28(4): 353–358.

58

Garcia-Aguilar J, Chow OS, Smith DD, et al. Effect of adding mFOLFOX6 after neoadjuvant chemoradiation in locally advanced rectal cancer: a multicentre, phase 2 trial. Lancet Oncol. 2015; 16(8): 957–966.

59

Fernandez-Martos C, Garcia-Albeniz X, Pericay C, et al. Chemoradiation, surgery and adjuvant chemotherapy versus induction chemotherapy followed by chemoradiation and surgery: long-term results of the Spanish GCR-3 phase Ⅱ randomized trialdagger. Ann Oncol. 2015; 26(8): 1722–1728.

60

Tao Wang, Mei Liu, Hualiang Yang, et al. Observation on the preventive and therapeutic effects of self-made radioactive enteritis enema on intestinal mucosal barrier injury in mice with acute radioactive enteritis. Shandong Med. 2019; 59(27): 38–41.

61

Wenshuang Zou, SongGe an, Zhuang Xiong, et al. Meta analysis of the efficacy of traditional Chinese medicine retention enema in the treatment of radiation proctitis [J]. J Mod Integr Tradit Chin West Med. 2015; 24(21): 2311–2315.

62

Jianming Yin, Boping Xu, Huixia Feng, et al. Clinical observation of single Scutellaria baicalensis in the prevention and treatment of acute radiation dermatitis. Chin J Integr Tradit West Med. 2001; 21(4): 304.

63

Lu X, Cai Y, Xia L, Ju H, Zhao X. Treatment modalities and relative survival in patients with brain metastasis from colorectal cancer. Biosci Trends. 2019; 13(2): 182–188.

64

Lai HW, Wei JC, Hung HC, Lin CC. Impact of treatment modality on clinical outcome in metastatic colorectal cancer patients stratified by metastatic sites. Postgrad Med. 2019; 131(2): 163–170.

65

Lanciano R, Lamond J, Yang J, et al. Stereotactic body radiation therapy for patients with heavily pretreated liver metastases and liver tumors. Front Oncol. 2012; 2: 23.

66

Zhao J, Yorke ED, Li L, et al. Simple factors associated with radiation-induced lung toxicity after stereotactic body radiation therapy of the thorax: a pooled analysis of 88 studies. Int J Radiat Oncol Biol Phys. 2016; 95(5): 1357–1366.

67

Hagemans JAW, van Rees JM, Alberda WJ, et al. Locally recurrent rectal cancer; long-term outcome of curative surgical and non-surgical treatment of 447 consecutive patients in a tertiary referral centre. Eur J Surg Oncol. 2020; 46(3): 448–454.

68

Westberg K, Palmer G, Hjern F, et al. Management and prognosis of locally recurrent rectal cancer—a national population-based study. Eur J Surg Oncol. 2018; 44(1): 100–107.

69

Al-Haidari G, Skovlund E, Undseth C. Re-irradiation for recurrent rectal cancer—a single-center experience. Acta Oncol. 2020; 14: 1–7.

70

Dowing A, Morris EJ, Ricards M, et al. Health related quality of life after colorectal cancer in England: a patient-reported outcomes study of individuals 12–36 months after diagnosis. J Clin Oncol. 2015; 33(6): 616–624.

Precision Radiation Oncology
Pages 4-31
Cite this article:
Liu S, Jin J. Radiotherapy guidelines for rectal cancer in China (2020 Edition). Precision Radiation Oncology, 2022, 6(1): 4-31. https://doi.org/10.1002/pro6.1141

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Received: 11 May 2022
Accepted: 13 September 2022
Published: 01 March 2022
© 2022 The Authors. Precision Radiation Oncology published by John Wiley & Sons Australia, Ltd on behalf of Shandong Cancer Hospital & Institute.

This is an open access article under the terms of the Creative Commons Attribution License, which permits use, distribution and reproduction in any medium, providedthe original work is properly cited.

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