ROMA (ITALPRESS) – More than 200 doctors gathered at the Istituto Nazionale Tumori Regina Elena for a conference dedicated to one of the most current themes of oncology: the balance between escalation and de-escalation in the treatment of cancer of the extraperitoneal rectum. An approach that marks the transition from standardized protocols to increasingly calibrated strategies on the individual patient. The initiative, promoted by Professor Roberto Santoro, head of the hepato-bilio-pancreatic digestive surgery of the Institute, saw the participation of some of the main experts in the field, including Carlo Garufi, Giuseppe Ettorre, Massimo Carlini and Professor Gianfranco Gualdi. At the heart of the debate, the two therapeutic strategies that today guide clinical choices. On the one hand, escalation, i.e. the intensification of care in more complex cases: locally advanced tumors, risk margins highlighted by magnetic resonance, unfavorable predictive factors. In these cases it is focused on neoadjuvant radiochemotherapy, combinations of treatments and, more and more often, on Total Neoadjuvant Therapy (TNT), which integrates chemotherapy and radiotherapy before surgery. The goal is clear: increase the control of the disease and reduce the risk of metastases. On the other hand, de-escalation represents the opposite but complementary frontier: reduce the intensity of care when possible, avoiding unnecessary toxicity. An option for patients with initial tumors or with full response to therapy, in which less invasive approaches can be adopted, up to the “watch and wait” strategy, which allows in some cases to avoid surgery while preserving the quality of life. The synthesis point emerged from the conference is a new vision of oncological care: no longer a unique model valid for all, but custom-built paths. Customization passes through advanced imaging – especially pelvic magnetic resonance – the evaluation of the response to cancer treatments and biological characteristics. “In oncology – it is the message shared by specialists – the challenge is not only to cure more, but to cure better.” The future of extraperitoneal rectum cancer treatment is played on this balance: maximizing effectiveness when necessary, reducing therapeutic impact when possible. A paradigm shift that focuses not only on survival, but also on the quality of patient life.
– photo Ipa Agency – (ITALPRESS).
