Course Report
Lower Gastrointestinal Tract: Technical and Clinical Challenges for Radiation Oncologists
22-24 March 2023, Florence, Italy
Could you please briefly introduce yourself?
I’m a radiation oncologist currently in my tenth year of clinical practice, with a background in brachytherapy for gynaecologic and prostate cancers. In recent years, my patient focus has shifted to a generalist scope of practice that includes more patients with gastrointestinal (GI) cancers.
Why did you choose to attend this course?
Many of my patients with rectal cancer might benefit from the latest treatment approaches such as total neoadjuvant therapy (TNT) or even, in some cases, non-operative management (NOM). Since I collaborate frequently with academic colorectal surgeons at nearby medical schools to treat my patients, I want to provide my patients with radiation oncology consultations that include the latest information regarding various TNT options, NOM, available clinical trials, and future approaches such as immunotherapy.
I have attended several outstanding ESTRO clinical courses since 2017 (on stereotactic body radiation therapy, brachytherapy; and on prostate, breast, lung, head & neck, and skin cancers). Therefore, I anticipated that ESTRO’s course on the lower GI tract would offer excellent teaching on the latest rectal and anal cancer treatment innovations directly from international experts. The faculty who taught this course are experts in radiation oncology, medical oncology, colorectal surgery, radiology and medical physics.
This 2023 edition of ESTRO’s lower GI course was particularly important given the relatively recent publication of results from important rectal cancer clinical trials such rectal cancer and pre-operative induction therapy followed by dedicated operation (RAPIDO); the use of pre-operative chemotherapy in patients with locally advanced rectal cancer (PRODIGE 23); organ preservation in patients with rectal adenocarcinoma treated through TNT (OPRA); and the German randomised phase-II trial of chemotherapy plus induction or consolidation chemotherapy as TNT for locally advanced rectal cancer (CAO/ARO/AIO-12). Many of these trials’ results were not yet available when the 2021 American Society for Radiation Oncology and the 2017 European Society for Medical Oncology clinical practice guidelines for rectal cancer were published.
What aspects of the course were the most interesting?
- Discussions about variations in sequencing TNT and clinical trial results.
- Tumour board case sessions among the course participants and expert course faculty.
- The story of the Brazilian rectal cancer surgeon Professor Habr-Gama.
- A deep dive into radiology MRI and the associated hands-on teaching session.
- A colorectal surgeon’s eye view of total mesorectal excision, transanal minimally invasive surgery and NOM.
- Clinical and timing nuances between long- and short-course rectal radiotherapy.
Did the course meet your expectations? If so, how?
The course exceeded my expectations. Beyond TNT, published clinical trials and the evolving standard of care, the course faculty dedicated ample time to forward-thinking topics. These included organ preservation approaches, new clinical trials, and immunotherapy. As a radiation oncologist, I was grateful for the very detailed cross-disciplinary teaching from ESTRO’s expert course faculty in colorectal surgery and radiology. Also, as an oncologist experienced in brachytherapy, I was impressed by the discussion about anal cancer brachytherapy, which I had never seen before.
How would you encourage someone who has never been to an ESTRO course to join this course next year / in two years?
The ESTRO School courses are an excellent form of continuing medical education that updates your knowledge base on a particular cancer site. You will have the opportunity to learn from world-class clinical teachers who are international experts in radiation oncology, medical oncology, surgery, radiology, physics, radiation therapy and dosimetry. Also, ESTRO School courses offer the opportunity to socialise with motivated peers who attend the courses from across the globe. These international peers can broaden your understanding of how cancer is treated in different parts of the world and help to enhance the care you give your patients.
In the evenings or days before/after each ESTRO course, you and your fellow course participants can enjoy the inspiring culture and history of the venue city. I was absolutely thrilled that the 2023 ESTRO lower GI course was held in the birthplace of the Renaissance - Florence, Italy.
Joseph Lee
Bay Pines VA Medical Center
Bay Pines, USA