Rectal cancer radiotherapy: towards European consensus.
OBJECTIVE
During the first decade of the 21st century several important European randomized studies in rectal cancer have been published. In order to help shape clinical practice based on best scientific evidence, the International Conference on 'Multidisciplinary Rectal Cancer Treatment: Looking for an European Consensus' (EURECA-CC2) was organized. This article summarizes the consensus about imaging and radiotherapy of rectal cancer and gives an update until May 2010.


METHODS
Consensus was achieved using the Delphi method. Eight chapters were identified: epidemiology, diagnostics, pathology, surgery, radiotherapy and chemotherapy, treatment toxicity and quality of life, follow-up, and research questions. Each chapter was subdivided by topic, and a series of statements were developed. Each committee member commented and voted, sentence by sentence three times. Sentences which did not reach agreement after voting round # 2 were openly debated during the Conference in Perugia (Italy) December 2008. The Executive Committee scored percentage consensus based on three categories: "large consensus", "moderate consensus", "minimum consensus".


RESULTS
The total number of the voted sentences was 207. Of the 207, 86% achieved large consensus, 13% achieved moderate consensus, and only three (1%) resulted in minimum consensus. No statement was disagreed by more than 50% of members. All chapters were voted on by at least 75% of the members, and the majority was voted on by >85%. Considerable progress has been made in staging and treatment, including radiation treatment of rectal cancer.


CONCLUSIONS
This Consensus Conference represents an expertise opinion process that may help shape future programs, investigational protocols, and guidelines for staging and treatment of rectal cancer throughout Europe. In spite of substantial progress, many research challenges remain.
Valentini
Vincenzo
V
Cattedra di Radioterapia, Università Cattolica S.Cuore, Rome, Italy. vvalentini@rm.unicatt.it
Glimelius
Bengt
B
D000970:Antineoplastic Agents / Q000627:therapeutic use; D017024:Chemotherapy, Adjuvant; D032921:Consensus; D003697:Delphi Technique; D005060:Europe; D019317:Evidence-Based Medicine; D005104:Expert Testimony; D006801:Humans; D008279:Magnetic Resonance Imaging; D058990:Molecular Targeted Therapy; D020360:Neoadjuvant Therapy / Q000379:methods; D009367:Neoplasm Staging; D049268:Positron-Emission Tomography; D011785:Quality Assurance, Health Care; D011788:Quality of Life; D011878:Radiotherapy / Q000009:adverse effects; D018714:Radiotherapy, Adjuvant; D016032:Randomized Controlled Trials as Topic; D012004:Rectal Neoplasms / Q000175:diagnosis* / Q000188:drug therapy / Q000453:epidemiology / Q000532:radiotherapy* / Q000601:surgery; D011795:Surveys and Questionnaires; D014057:Tomography, X-Ray Computed
D000970:Antineoplastic Agents