Chiorean E Gabriela, Nandakumar Govind, Fadelu Temidayo, Temin Sarah, Alarcon-Rozas Ashley Efrain, Bejarano Suyapa, Croitoru Adina-Emilia, Grover Surbhi, Lohar Pritesh V, Odhiambo Andrew, Park Se Hoon, Garcia Erika Ruiz, Teh Catherine, Rose Azmina, Zaki Bassem, Chamberlin Mary D
University of Washington, Fred Hutchinson Cancer Research Center, Seattle, WA.
Columbia Asia Hospitals, Bangalore, India.
JCO Glob Oncol. 2020 Mar;6:414-438. doi: 10.1200/JGO.19.00367.
To provide expert guidance to clinicians and policymakers in resource-constrained settings on the management of patients with late-stage colorectal cancer.
ASCO convened a multidisciplinary, multinational Expert Panel that reviewed existing guidelines, conducted a modified ADAPTE process, and used a formal consensus process with additional experts for two rounds of formal ratings.
Existing sets of guidelines from four guideline developers were identified and reviewed; adapted recommendations from five guidelines form the evidence base and provided evidence to inform the formal consensus process, which resulted in agreement of ≥ 75% on all recommendations.
Common elements of symptom management include addressing clinically acute situations. Diagnosis should involve the primary tumor and, in some cases, endoscopy, and staging should involve digital rectal exam and/or imaging, depending on resources available. Most patients receive treatment with chemotherapy, where chemotherapy is available. If, after a period of chemotherapy, patients become candidates for surgical resection with curative intent of both primary tumor and liver or lung metastatic lesions on the basis of evaluation in multidisciplinary tumor boards, the guidelines recommend patients undergo surgery in centers of expertise if possible. On-treatment surveillance includes a combination of taking medical history, performing physical examinations, blood work, and imaging; specifics, including frequency, depend on resource-based setting.Additional information is available at www.asco.org/resource-stratified-guidelines.
为资源有限地区的临床医生和政策制定者提供关于晚期结直肠癌患者管理的专家指导。
美国临床肿瘤学会召集了一个多学科、跨国专家小组，该小组审查了现有指南，进行了改良的ADAPTE流程，并与其他专家采用正式的共识流程进行两轮正式评级。
确定并审查了来自四个指南制定者的现有指南集；来自五个指南的适应性建议构成了证据基础，并为正式的共识流程提供了依据，所有建议达成了≥75%的共识。
症状管理的共同要素包括处理临床急症情况。诊断应包括原发性肿瘤，在某些情况下还应包括内镜检查，分期应根据可用资源进行直肠指检和/或影像学检查。大多数患者在有化疗药物的情况下接受化疗。如果经过一段时间的化疗后，根据多学科肿瘤委员会的评估，患者有治愈原发性肿瘤及肝或肺转移灶的手术切除指征，指南建议患者尽可能在专业中心接受手术。治疗期间的监测包括病史采集、体格检查、血液检查和影像学检查的综合；具体细节，包括频率，取决于资源状况。更多信息可在www.asco.org/resource-stratified-guidelines获取。
