Noam VanderWalde, MD, MS, an associate professor of radiation oncology at West Cancer Center and Research Institute, discusses the importance of implementing multidisciplinary care for patients with rectal cancer. 

The armamentarium in rectal cancer has expanded significantly over the years, explains VanderWalde. Moreover, there is no established standard of care for patients and multiple treatments can be utilized. 

As such, treatment decisions should be made in a multidisciplinary setting that includes medical oncologists, surgeons, and radiation oncologists, VanderWalde says. Notably, patient preference, as well as the specific characteristics of their disease, should be taken into account during treatment selection. 

Presenting rectal cancer cases in a multidisciplinary clinic, as well as considering expert opinion, could provide the optimal care for patients in this space, concludes VanderWalde.

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Noam VanderWalde, MD, MS, discusses the importance of implementing multidisciplinary care for patients with rectal cancer.  



Dr. VanderWalde on the Importance of Multidisciplinary Care in Rectal Cancer 

Noam VanderWalde, MD, MS, an associate professor of radiation oncology at West Cancer Center and Research Institute, discusses radiation therapy in early-stage versus later-stage rectal cancer.

In patients with earlier-stage disease, for example, those with node-negative disease, the use of preoperative radiation therapy is dependent on the tumor location, says VanderWalde. In a patient who has high-grade rectal cancer, such as T2 or T3, it may be preferred to avoid radiation, added VanderWalde. Data from several studies have demonstrated that patients with high T3 disease have a very low risk of locoregional recurrence. 

That being said, a low-lying rectal cancer may require abdominoperineal resection (APR) if the patient did not receive any downstaging, says VanderWalde. In those patients, radiation may be used even though they have a lower-stage cancer. The goal of this is to provide patients with nonoperative management of their disease or to go from an APR to a low anterior resection, concludes VanderWalde.

Noam VanderWalde, MD, MS, discusses radiation therapy in early-stage versus later-stage rectal cancer.
 

Dr. VanderWalde on Utility of Radiation Therapy in Rectal Cancer

Noam VanderWalde, MD, MS, associate professor of radiation oncology, West Cancer Center and Research Institute, discusses ​where future research ​efforts should focus in rectal cancer. 

Treatment personalization in terms of medical management, patient preference, and health-related quality of life, needs to be further evaluated, says VanderWalde. 

Moreover, factors that influence decision making should be assessed, VanderWalde explains.

Typically, surgical eligibility based on results from physical exams and and MRI; however, circulating tumor DNA may provide better insight ​on whether a patient should undergo surgery, VanderWalde concludes.

Noam VanderWalde, MD, MS, discusses ​where future research ​efforts should focus in rectal cancer. 

Dr. VanderWalde on Future Research in Rectal Cancer 

Noam VanderWalde, MD, MS, associate professor of radiation oncology, West Cancer Center and Research Institute, discusses the push toward personalizing therapy in rectal cancer.

Multiple standards of care are available for patients with rectal cancer, explains VanderWalde. 

Historically, all patients with locally advanced rectal cancer received preoperative chemoradiation, VanderWalde says. In general, patients in the United States received long-course chemoradiation, whereas patients in Europe received short-course chemoradiation. 

Following surgery, patients received chemotherapy as needed, VanderWalde adds. 

The advent of total neoadjuvant therapy has expanded the armamentarium for patients in this space, says VanderWalde.

Treatment selection should be considered by a multidisciplinary team, including radiation oncologists, surgeons, and medical oncologists to optimize therapy for patients, VanderWalde concludes. 

Noam VanderWalde, MD, MS, discusses the push toward personalizing therapy in rectal cancer.  



Noam VanderWalde, MD, MS

Articles

Dr. VanderWalde on the Importance of Multidisciplinary Care in Rectal Cancer

Dr. VanderWalde on Utility of Radiation Therapy in Rectal Cancer

Dr. VanderWalde on Future Research in Rectal Cancer

Dr. VanderWalde on Personalizing Therapy in Rectal Cancer