Radiotherapy and oncology : journal of the European Society for Therapeutic Radiology and Oncology
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Randomized Controlled Trial Multicenter Study
Compliance and tolerability of short-course radiotherapy followed by preoperative chemotherapy and surgery for high-risk rectal cancer - Results of the international randomized RAPIDO-trial.
Preoperative chemoradiotherapy (CRT) followed by total mesorectal excision is widely accepted as the standard of care for high-risk rectal cancer. Adjuvant chemotherapy is advised in several international guidelines, although the survival benefit remains unclear and compliance is poor. The current multidisciplinary approach has led to major improvements in local control, yet the occurrence of distant metastases has not decreased accordingly. The combination of short-course radiotherapy (SCRT) and chemotherapy in the waiting period before surgery might have several benefits, including higher compliance, downstaging and better effect of systemic therapy. ⋯ High compliance (84%) of preoperative systemic treatment could be achieved with the experimental approach. Although considerable toxicity was observed during preoperative therapy, this did not lead to differences in surgical procedures or postoperative complications. Longer follow-up time is needed to assess the primary endpoint and related outcomes.
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Global curricula exist across medical specialties however, the factors which influence their implementation are not well understood. The purpose of this study is to report the perceived factors that impact the implementation of the ESTRO Core Curriculum. ⋯ The content and values espoused in the ESTRO Core Curriculum are endorsed across diverse geopolitical and sociocultural regions. Barriers to curricular implementation are identified at the organizational and systems level and include insufficient teaching faculty, lack of coordination and the need for influential leadership.