Patient-centered developments in colon- and rectal cancer with a multidisciplinary international team: From translational research to national guidelines

Abstract

Rarely, scientific developments centered around the patient as a whole are published. Our multidisciplinary group, headed by gastrointestinal surgeons, applied this research philosophy considering the most important aspects of the diseases "colon- and rectal cancer" in the long-term developments. Good expert cooperation/knowledge at the Comprehensive Cancer Center Ulm (CCCU) were applied in several phase III trials for multimodal treatments of primary tumors (MMT) and metastatic diseases (involving nearly 2000 patients and 64 centers), for treatment individualization of MMT and of metastatic disease, for psycho-oncology/quality of life involving the patients' wishes, and for disease prevention. Most of the targets initially were heavily rejected/discussed in the scientific communities, but now have become standards in treatments and national guidelines or are topics in modern translational research protocols involving molecular biology for e.g., "patient centered individualized treatment". In this context we also describe the paths we had to tread in order to realize our new goals, which at the end were highly beneficial for the patients from many points of view. This description is also important for students and young researchers who, with an actual view on our recent developments, might want to know how medical progress was achieved.

Keywords: Colon- and rectal cancer; Interdisciplinary treatment; National guidelines; Personalized treatment; Translational research.

Figure 1

Examples for surgical treatment recommendations in the FOGT protocols and quality level of one participant´s surgical team applying these recommendations (Link KH) in the benchmarking of German Cancer Society Bowel Centers. A: The best standard-of-care in rectal resection was total mesorectal excision according to Heald RJ; B: Lateral nerve preserving lymph node dissection could be applied in cases with lateral LN-metastasis (diagnosed in the preoperative MRI) according to Mori T; C: The variation of results of quality control in German Bowel Centers is demonstrated [marked in red color is the position of APK Wiesbaden under leadership of the first author; dark green = bowel units that were rated as top groups (Link KH)].

Figure 2

Individualized multistep treatment of a patient with primarily nonresectable isolated colorectal liver metastasis. A 35-yr-old woman with bi-lobal metastatic disease in the first step was partially resected by extended right hemihepatectomy, then treated with individualized hepatic artery infusion chemotherapy (HAI), then R0 resected by atypical resections on the left side. She then received three cycles of postoperative adjuvant chemotherapy applying the same HAI protocol. The resected metastases on the left side had shown nearly complete pathological responses. The patient lived tumor free for 7 yr and then presented with obstructive lymphangiosis in the hepatoduodenal ligament. She died due to disease progression after treatment with systemic chemotherapy.

Figure 3

German action for secondary prevention of colon- and rectal cancers by colonoscopy/polyp excision. Public action “1000 brave men” (left, “1000 Mutige Männer”) with support of public personalities in sports (left, Otto K, Olympic gold medal champion) and politics (right, Bouffier V, Hessian state prime minister).