SEOM Clinical guidelines for the treatment of advanced colorectal cancer 2013
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CLINICAL GUIDES IN ONCOLOGY
SEOM Clinical guidelines for the treatment of advanced colorectal cancer 2013 E. Casado-Saenz • J. Feliu • M. A. Gomez-Espan˜a A. Sanchez-Gastaldo • R. Garcia-Carbonero
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Received: 28 June 2013 / Accepted: 16 July 2013 Federacio´n de Sociedades Espan˜olas de Oncologı´a (FESEO) 2013
Abstract Colorectal cancer (CRC) is the most common malignant tumor in Western countries. Despite efforts made to implement screening programmes for early detection and treatment, still half of the patients present or will eventually develop distant metastasis. Management of advanced CRC should be discussed within an experienced multidisciplinary team, to adequately select the most appropriate systemic therapeutic option, as well as the optimal way to integrate it with surgical procedures when indicated. Disease localization and extent, resectability of primary and metastatic disease, tumor biology and dynamics, clinical symptoms, personal preferences and patient’s ability to tolerate intensive chemotherapy or extensive surgical procedures are the key factors to properly design a customized treatment plan. The aim of the current manuscript is to provide synthetic practical guidelines regarding therapeutic options for advanced CRC.
Keywords Colorectal cancer Guidelines Chemotherapy Surgery
Introduction Colorectal cancer (CRC) is the most frequent cancer in Spain and the second cause of cancer death, with an estimation of over 30,000 incident cases in 2012, half of which will eventually die [1]. Up to one-third of patients present with advanced disease at diagnosis, and about 40 % of early stage disease relapse at some point during the disease course. Although prognosis has greatly improved over the past decades due to significant surgical and medical advances, once the tumor has progressed beyond surgical resectability, the disease is essentially incurable and median survival is about 2 years with best available systemic therapy.
Diagnosis and staging E. Casado-Saenz Medical Oncology Department, Hospital Infanta Sofia, Madrid, Spain J. Feliu Medical Oncology Department, Hospital La Paz, Madrid, Spain M. A. Gomez-Espan˜a Medical Oncology Department, Hospital Reina Sofia, Co´rdoba, Spain A. Sanchez-Gastaldo R. Garcia-Carbonero (&) Servicio de Oncologı´a Me´dica, Hospital Universitario Virgen del Rocı´o, Instituto de Biomedicina de Sevilla (IBIS) [Universidad de Sevilla, CSIC, HUVR], Avenida Manuel Siurot, S/N, 41013 Sevilla, Spain e-mail: [email protected]
Diagnosis In order to properly stratify patients to optimize the individual therapeutic strategy, the extent of disease shall be carefully assessed, as well as tumor-biology and patientrelated factors. The following procedures shall be performed and evaluated within a multidisciplinary team that shall include experienced liver and/or thoracic surgeons to identify patients with metastatic colorectal cancer for which potentially curative surgical options are available: –
History and physical examination (the general condition, including per
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