EP980 - Evaluation of Rectal Cancer Patients Under the PROSPECT Trial Approach in an Accredited Rectal Cancer Program

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Purpose/Background:

Introduction: De escalation of chemoradiation in patients with radiographic T2/3 and/or N1 mid to high rectal cancer has been demonstrated to be non-inferior by the PROSPECT trial. While this approach has been validated in those patients with mid to high tumors, the efficacy on omitting chemoradiation in low tumors is not clear. We sought to characterize factors associated with de-escalation at a single institution, accredited rectal cancer program

Methods/Interventions:

Methods: We performed a retrospective review of prospectively collected data of patients treated for rectal cancer at a single institution, nationally accredited rectal cancer program. Clinical staging, tumor characteristics, and proximity to the anal verge were assessed. Clinical characteristics leading to de-escalation were profiled.

Results/Outcomes:

Results: we evaluated 44 newly diagnosed rectal cancer patients from January to September 2024. Of these, 14 patients were recommended for treatment under the PROSPECT trial protocol, a personalized strategy that tailors treatment based on tumor location and nodal involvement. Eight of these 14 patients had tumors located less than 10 cm from the anal verge (AV), with an average distance of 8-9 cm. Most of these tumors were staged as T3N+M0 or T2N+. Five patients had a history of prior radiation therapy for other malignancies, four for colon cancer and one for prostate cancer, requiring further chemotherapy and/or surgical interventions for rectal cancer.

Conclusion/Discussion: This study highlights the significant impact of personalized, evidence-based approaches like the PROSPECT trial in the management of rectal cancer patients. The high prevalence of advanced rectal cancer (T3N+) in patients with tumors located near the anal verge underscores the necessity for meticulous preoperative planning and a comprehensive multidisciplinary care approach. Continued participation in the PROSPECT trial will allow for further refinement of treatment protocols, promoting adherence to best practices and improving patient outcomes.