Table of Contents

• Part 1: Is Local Excision Appropriate?
  1. A word from the editor
  2. Introduction
  3. Local Excision Alone
  4. Local Excision Followed by Postoperative Therapy
  5. Sphincter Function
  6. Preoperative Therapy Followed by Local Excision
  7. Chemotherapy
  8. Summary
  9. References
      
• Part 2: Are 3D or IMRT Techniques Helpful?
  1. Introduction
  2. Radiation Therapy Planning and IMRT
  3. Dose-Response Relationship in Rectal Cancer
  4. Normal Tissue Toxicity
  5. Disease-Related Outcomes
  6. Conclusion/Key Points
  7. Future Strategies
  8. References
      

Other E-Updates in This Series:

Controversies in Preoperative Chemoradiation for Rectal Cancer:

Part 1: Is there a Role for Postoperative Chemotherapy?
Part 2: Are Novel Chemoradiation Regimens More Effective?

CONTINUING MEDICAL EDUCATION

Activity Release Date: September 15, 2009
Activity Expiration Date: September 15, 2010

Needs Assessment
Since the early 1990s, postoperative adjuvant chemoradiotherapy was widely viewed as the main approach to treat patients with stage II and III rectal cancer. Over the past few years, significant efforts have shifted towards developing neoadjuvant approaches, which combine chemotherapy with radiotherapy prior to surgical resection.

CME LLC has collaborated with a team of oncology and hematology specialists to provide insight into currently unresolved treatment dilemmas. In Controversies in the Management of Rectal Cancer, these experts write about recent advances that are pertinent for oncology practice, and provide a reasoned and practical perspective that may advance patient care.

Learning Objectives
Upon completing this activity, participants should be able to

• assess the use of postoperative adjuvant chemotherapy following chemoradiation.
• appraise new and novel preoperative chemoradiation regimens.
• appraise the role of local excision in the surgical management of rectal cancer.
• demonstrate knowledge of the role of available types of radiation therapy — conventional, 3D, and IMRT.
   

Target Audience
This activity was designed to meet the continuing medical education needs of oncologists and hematologists involved in the care of rectal cancer patients.

Estimated Time to Complete
The activity in its entirety should take approximately 2 hours to complete. Participants will have the opportunity to earn 2 AMA PRA Category 1 Credits™ at the completion of the CME activity.

Supporter Statement
This activity is supported by an educational grant from Genentech BioOncology.

Compliance Statement
This activity is an independent educational activity under the direction of CME LLC. The activity was planned and implemented in accordance with the Essential Areas and policies of the ACCME, the Ethical Opinions/Guidelines of the AMA, the FDA, the OIG, and the PhRMA Code on Interactions with Healthcare Professionals, thus assuring the highest degree of independence, fair balance, scientific rigor, and objectivity.

Accreditation Statement
CME LLC is accredited by the Accreditation Council for Continuing Medical Education to provide continuing medical education for physicians.

Credit Designation
CME LLC designates this educational activity for a maximum of 2 AMA PRA Category 1 Credits™. Physicians should only claim credit commensurate with the extent of their participation in the activity.

Faculty Disclosures
Dr. Minsky serves as a consultant and is on the speakers bureau for sanofi-aventis U.S., Genentech, Inc., and Bristol-Myers Squibb Company. Dr. Czito and Dr. Willett have indicated no relationships to disclose.

This activity has been independently reviewed for balance.

Disclaimer
The opinions and recommendations expressed by faculty and other experts whose input is included in this activity are their own and do not necessarily reflect the views of the sponsor or supporter. Discussions concerning drugs, dosages, and procedures may reflect the clinical experience of the faculty or may be derived from the professional literature or other sources and may suggest uses that are investigational in nature and not approved labeling or indications. Activity participants are encouraged to refer to primary references or full prescribing information resources.

Method of Participation
Participants are required to read this E-Update to be eligible to take the CME posttest and complete a short evaluation. Successful completion of the posttest with a passing score of 80% or better earns the participant 2 CME credits.

Contact Information
We would like to hear your comments regarding this or other programs provided by CME LLC. In addition, suggestions for future programming are welcome. Contact us at:

Director, Continuing Medical Education
CME LLC
Harborside Financial Center
Plaza 3, Suite 806
Jersey City, NJ 07311
Phone: 800-447-4474
Fax: 201-946-0700

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