TY - JOUR
T1 - Delphi Initiative for Early-Onset Colorectal Cancer (DIRECt) International Management Guidelines
AU - Associazione Italiana Familiarità Ereditarietà Tumori
AU - the Collaborative Group of the Americas on Inherited Gastrointestinal Cancer
AU - the European Hereditary Tumour Group, and the International Society for Gastrointestinal Hereditary Tumours
AU - Cavestro, Giulia Martina
AU - Mannucci, Alessandro
AU - Balaguer, Francesc
AU - Hampel, Heather
AU - Kupfer, Sonia S.
AU - Repici, Alessandro
AU - Sartore-Bianchi, Andrea
AU - Seppälä, Toni T.
AU - Valentini, Vincenzo
AU - Boland, Clement Richard
AU - Brand, Randall E.
AU - Buffart, Tineke E.
AU - Burke, Carol A.
AU - Caccialanza, Riccardo
AU - Cannizzaro, Renato
AU - Cascinu, Stefano
AU - Cercek, Andrea
AU - Crosbie, Emma J.
AU - Danese, Silvio
AU - Dekker, Evelien
AU - Daca-Alvarez, Maria
AU - Deni, Francesco
AU - Dominguez-Valentin, Mev
AU - Eng, Cathy
AU - Goel, Ajay
AU - Guillem, Josè G.
AU - Houwen, Britt B.S.L.
AU - Kahi, Charles
AU - Kalady, Matthew F.
AU - Kastrinos, Fay
AU - Kühn, Florian
AU - Laghi, Luigi
AU - Latchford, Andrew
AU - Liska, David
AU - Lynch, Patrick
AU - Malesci, Alberto
AU - Mauri, Gianluca
AU - Meldolesi, Elisa
AU - Møller, Pål
AU - Monahan, Kevin J.
AU - Möslein, Gabriela
AU - Murphy, Caitlin C.
AU - Nass, Karlijn
AU - Ng, Kimmie
AU - Oliani, Cristina
AU - Papaleo, Enrico
AU - Patel, Swati G.
AU - Ricciardiello, Luigi
AU - Vilar, Eduardo
AU - You, Yi Qian Nancy
N1 - Publisher Copyright:
© 2023 The Authors
PY - 2023/3
Y1 - 2023/3
N2 - 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.
AB - 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.
KW - 50 Years
KW - Clinical
KW - Colorectal Cancer
KW - Recommendation
KW - Young
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U2 - 10.1016/j.cgh.2022.12.006
DO - 10.1016/j.cgh.2022.12.006
M3 - Article
C2 - 36549470
AN - SCOPUS:85146579486
SN - 1542-3565
VL - 21
SP - 581-603.e33
JO - Clinical Gastroenterology and Hepatology
JF - Clinical Gastroenterology and Hepatology
IS - 3
ER -