Ankara University Medical School, Ankara, Turkey.
J Natl Compr Canc Netw. 2010 Jul;8 Suppl 3:S22-5. doi: 10.6004/jnccn.2010.0120.
Colorectal cancer is less common in the Middle East and South Asia than in western countries, with the rectum the most common primary site, unlike in the United States. A project was planned to address various local issues regarding the management of common cancers, including colorectal cancer, and to adapt the NCCN Clinical Practice Guidelines in Oncology (NCCN Guidelines) to the Middle East and North Africa (MENA) region. A survey of oncologists in this geographic area showed that the management practices and issues regarding colorectal cancer are similar to those presented in the NCCN Colorectal Cancer Guidelines. However, 2 major differences exist: most oncologists in the MENA region prefer chest radiograph over CT in pretreatment workup, and almost 50% of them prefer to use cetuximab in the first-line treatment of patients with the wild-type KRAS gene. The committee, comprising 9 oncologists from different countries, proposed 4 modifications to the 2009 version of the NCCN Colorectal Cancer Guidelines for use in the MENA region, relating to 1) short-course preoperative radiotherapy, 2) dose of capecitabine, 3) stereotactic radiotherapy for liver metastasis, and 4) qualification of surgeons performing colorectal surgery. The modification of NCCN Colorectal Cancer Guidelines for use in the MENA region represents a step toward creating a uniform practice in the region based on evidence and local experience.
结直肠癌在中东和南亚的发病率低于西方国家，以直肠为最常见的原发部位，这与美国不同。该项目旨在解决常见癌症（包括结直肠癌）管理方面的各种当地问题，并使 NCCN 肿瘤临床实践指南（NCCN 指南）适应中东和北非（MENA）地区。对该地理区域的肿瘤学家进行的一项调查显示，结直肠癌的管理实践和问题与 NCCN 结直肠癌指南中提出的相似。然而，存在 2 个主要差异：MENA 地区的大多数肿瘤学家在治疗前检查中更喜欢胸部 X 光而不是 CT，并且几乎有 50％的人更喜欢在 KRAS 基因野生型患者的一线治疗中使用西妥昔单抗。由来自不同国家的 9 位肿瘤学家组成的委员会对 2009 年版 NCCN 结直肠癌指南提出了 4 项修改，涉及 1）短程术前放疗，2）卡培他滨的剂量，3）肝转移的立体定向放疗，以及 4）结直肠手术的外科医生资格。对 NCCN 结直肠癌指南的修改是朝着在该地区基于证据和当地经验建立统一实践迈出的一步。
