HJBR Mar/Apr 2020

38 MAR / APR 2020 I  HEALTHCARE JOURNAL OF BATON ROUGE COLUMN ONCOLOGY Kelly Finan, MD, MSPH, FACS, FASCRS Colorectal Surgeon Mary Bird Perkins–Our Lady of the Lake Cancer Center DEFINITIVE TREATMENT for locally advanced rectal cancer (LARC) typical- ly involves surgical resection, with either pre-operative or post-operative chemo- therapy and radiation. How this is optimal- ly sequenced has been an evolving debate, with institutional preferences and histor- ical experience guiding practice at each cancer center. In general, the emerging standard is preoperative chemoradiation, followed by resection and postoperative chemotherapy. This approach obtains a cure rate for over 70 percent, but still re- mains challenging in terms of major neg- ative impacts on quality of life, stool fre- quency and urge, and rarely, needing total colostomy due to low lying or extremely locally advanced tumors. In this landscape, total neoadjuvant therapy (TNT) has emerged as a viable strategy for LARC patients, inwhich the to- tal course of chemotherapy and radiation is delivered pre-operatively. In practice, Louisiana has the fourth highest colorectal cancer (CRC) death rate in the United States.While there are a number of reasons for this significant health issue, bar- riers to screening, as well as high rates of tobacco and obesity, all contribute to the burden of CRC in our state. Afifth of Louisiana’s population is eligible for screening (age 50 to 75), but only two-thirds of this group obtains it, leaving over 400,000 Louisianans at risk. Despite great efforts to improve screening in recent years, this ultimately results in more locally advanced disease at initial presentation. AN EMERGING APPROACH TO PERSONALIZED TREATMENT FOR ADVANCED RECTAL CANCER