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Active involvement of patients, radiation oncologists, and surgeons in a multidisciplinary team approach: Guiding local therapy in recurrent, metastatic rectal cancer

 Seo Hee Choi  ;  Gowoon Yang  ;  Woong Sub Koom  ;  Seung Yoon Yang  ;  Seung-Seob Kim  ;  Joon Seok Lim  ;  Han Sang Kim  ;  Sang Joon Shin  ;  Jee Suk Chang 
 CANCER MEDICINE, Vol.12(22) : 21057-21067, 2023-11 
Journal Title
Issue Date
Humans ; Neoadjuvant Therapy ; Neoplasms, Second Primary* ; Patient Care Team ; Radiation Oncologists ; Rectal Neoplasms* / pathology ; Surgeons*
decision making ; multidisciplinary team ; oligometastasis ; patient outcomes ; rectal cancer ; salvage therapy
Background: Despite the extensive implementation of an organized multidisciplinary team (MDT) approach in cancer treatment, there is little evidence regarding the optimal format of MDT. We aimed to investigate the impact of patient participation in MDT care on the actual application rate of metastasis-directed local therapy.

Methods: We identified all 1211 patients with locally advanced rectal cancer treated with neoadjuvant radiochemotherapy at a single institution from 2006 to 2018. Practice patterns, tumor burden and OMD state were analyzed in recurrent, metastatic cases.

Results: With a median follow-up of 60.7 months, 281 patients developed metastases, and 96 (34.2%), 92 (32.7%), and 93 (33.1%) patients had 1, 2-5, and >5 lesions, respectively. In our study, 27.1% were managed in the MDT clinic that mandated the participation of at least four to five board-certified multidisciplinary experts and patients in decision-making processes, while the rest were managed through diverse MDT approaches such as conferences, tumor board meetings, and discussions conducted via phone calls or email. Management in MDT clinic was significantly associated with more use of radiotherapy (p = 0.003) and more sessions of local therapy (p < 0.001). At the time of MDT clinic, the number of lesions was 1, 2-5, and >5 in 9 (13.6%), 35 (53.1%), and 19 (28.8%) patients, respectively. The most common states were repeat OMD (28.8%) and de novo OMD (27.3%), followed by oligoprogression (15%) and induced OMD (10.6%).

Conclusion: Our findings suggest that active involvement of patients and radiation oncologists, and surgeons in MDT care has boosted the probability of using local therapies for various types of OMD throughout the course of the disease.
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Appears in Collections:
1. College of Medicine (의과대학) > Dept. of Internal Medicine (내과학교실) > 1. Journal Papers
1. College of Medicine (의과대학) > Dept. of Radiation Oncology (방사선종양학교실) > 1. Journal Papers
1. College of Medicine (의과대학) > Dept. of Radiology (영상의학교실) > 1. Journal Papers
1. College of Medicine (의과대학) > Dept. of Surgery (외과학교실) > 1. Journal Papers
Yonsei Authors
Koom, Woong Sub(금웅섭) ORCID logo https://orcid.org/0000-0002-9435-7750
Kim, Seung-seob(김승섭) ORCID logo https://orcid.org/0000-0001-6071-306X
Kim, Han Sang(김한상) ORCID logo https://orcid.org/0000-0002-6504-9927
Shin, Sang Joon(신상준) ORCID logo https://orcid.org/0000-0001-5350-7241
Yang, Gowoon(양고운)
Yang, Seung Yoon(양승윤) ORCID logo https://orcid.org/0000-0001-8129-7712
Lim, Joon Seok(임준석) ORCID logo https://orcid.org/0000-0002-0334-5042
Chang, Jee Suk(장지석) ORCID logo https://orcid.org/0000-0001-7685-3382
Choi, Seo Hee(최서희) ORCID logo https://orcid.org/0000-0002-4083-6414
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