Delphi initiative for early-onset colorectal cancer (DIRECt) international management guidelines Guidelines

  


Authors: Cavestro, G. M.; Mannucci, A.; Balaguer, F.; Hampel, H.; Kupfer, S. S.; Repici, A.; Sartore-Bianchi, A.; Seppälä, T. T.; Valentini, V.; Boland, C. R.; Brand, R. E.; Buffart, T. E.; Burke, C. A.; Caccialanza, R.; Cannizzaro, R.; Cascinu, S.; Cercek, A.; Crosbie, E. J.; Danese, S.; Dekker, E.; Daca-Alvarez, M.; Deni, F.; Dominguez-Valentin, M.; Eng, C.; Goel, A.; Guillem, J. G.; Houwen, B. B. S. L.; Kahi, C.; Kalady, M. F.; Kastrinos, F.; Kühn, F.; Laghi, L.; Latchford, A.; Liska, D.; Lynch, P.; Malesci, A.; Mauri, G.; Meldolesi, E.; Møller, P.; Monahan, K. J.; Möslein, G.; Murphy, C. C.; Nass, K.; Ng, K.; Oliani, C.; Papaleo, E.; Patel, S. G.; Puzzono, M.; Remo, A.; Ricciardiello, L.; Ripamonti, C. I.; Siena, S.; Singh, S. K.; Stadler, Z. K.; Stanich, P. P.; Syngal, S.; Turi, S.; Urso, E. D.; Valle, L.; Vanni, V. S.; Vilar, E.; Vitellaro, M.; You, Y. Q. N.; Yurgelun, M. B.; Zuppardo, R. A.; Stoffel, E. M.; on behalf of the Associazione Italiana Familiarita EreditarietaTumori; the Collaborative Group of the Americas on Inherited Gastrointestinal, Cancer; the European Hereditary Tumour Group; and the International Society for Gastrointestinal Hereditary Tumours
Title: Delphi initiative for early-onset colorectal cancer (DIRECt) international management guidelines
Abstract: Background & Aims: Patients with early-onset colorectal cancer (eoCRC) are managed according to guidelines that are not age-specific. A multidisciplinary international group (DIRECt), composed of 69 experts, was convened to develop the first evidence-based consensus recommendations for eoCRC. Methods: After reviewing the published literature, a Delphi methodology was used to draft and respond to clinically relevant questions. Each statement underwent 3 rounds of voting and reached a consensus level of agreement of ≥80%. Results: The DIRECt group produced 31 statements in 7 areas of interest: diagnosis, risk factors, genetics, pathology-oncology, endoscopy, therapy, and supportive care. There was strong consensus that all individuals younger than 50 should undergo CRC risk stratification and prompt symptom assessment. All newly diagnosed eoCRC patients should receive germline genetic testing, ideally before surgery. On the basis of current evidence, endoscopic, surgical, and oncologic treatment of eoCRC should not differ from later-onset CRC, except for individuals with pathogenic or likely pathogenic germline variants. The evidence on chemotherapy is not sufficient to recommend changes to established therapeutic protocols. Fertility preservation and sexual health are important to address in eoCRC survivors. The DIRECt group highlighted areas with knowledge gaps that should be prioritized in future research efforts, including age at first screening for the general population, use of fecal immunochemical tests, chemotherapy, endoscopic therapy, and post-treatment surveillance for eoCRC patients. Conclusions: The DIRECt group produced the first consensus recommendations on eoCRC. All statements should be considered together with the accompanying comments and literature reviews. We highlighted areas where research should be prioritized. These guidelines represent a useful tool for clinicians caring for patients with eoCRC. © 2023 The Authors
Keywords: cancer chemotherapy; cancer surgery; cancer risk; cancer patient; cancer diagnosis; colorectal cancer; consensus; evidence based practice; patient monitoring; practice guideline; pathology; cancer therapy; age; cancer survivor; cancer genetics; germ line; delphi study; young; genetic screening; onset age; endoscopy; feces; immunochemistry; medical expert; fertility preservation; clinical; sexual health; recommendation; clinical significance; human; article; stratified sample; 50 years
Journal Title: Clinical Gastroenterology and Hepatology
Volume: 21
Issue: 3
ISSN: 1542-3565
Publisher: Elsevier Science, Inc.  
Date Published: 2023-03-01
Start Page: 581
End Page: 603.e33
Language: English
DOI: 10.1016/j.cgh.2022.12.006
PUBMED: 36549470
PROVIDER: scopus
DOI/URL:

https://www.scopus.com/inward/record.uri?eid=2-s2.0-85146579486&doi=10.1016%2fj.cgh.2022.12.006&partnerID=40&md5=1807951b5265dc5d8e52db989711469c
Notes: Article -- Export Date: 1 March 2023 -- Source: Scopus
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