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    Delphi initiative for early-onset colorectal cancer (DIRECt). International Management Guidelines

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    Authors
    Cavestro Giulia, M.
    Mannucci, A.
    Balaguer, F.
    Hampel, H.
    Kupfer, S. S.
    Repici, A.
    Sartore-Bianchi, A.
    Seppälä Toni, T.
    Valentini, V.
    Boland Clement, R.
    Brand, R. E.
    Buffart, T. E.
    Burke, C. A.
    Caccialanza, R.
    Cannizzaro, R.
    Cascinu, S.
    Cercek, A.
    Crosbie, Emma J
    Danese, S.
    Dekker, E.
    Daca-Alvarez, M.
    Deni, F.
    Dominguez-Valentin, M.
    Eng, C.
    Goel, A.
    Guillem Josè, G.
    Houwen, B.
    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.
    Moslein, G.
    Murphy, C. C.
    Nass, K.
    Ng, K.
    Oliani, C.
    Papaleo, E.
    Patel, S. G.
    Puzzono, M.
    Remo, A.
    Ricciardiello, L.
    Ripamonti Carla, I.
    Siena, S.
    Singh, S. K.
    Stadler, Z. K.
    Stanich, P. P.
    Syngal, S.
    Turi, S.
    Urso Emanuele, D.
    Valle, L.
    Vanni Valeria, S.
    Vilar, E.
    Vitellaro, M.
    You, Y. N.
    Yurgelun, M. B.
    Zuppardo Raffaella, A.
    Stoffel, E. M.
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    Affiliation
    Gastroenterology and Gastrointestinal Endoscopy Unit, Vita-Salute San Raffaele University, IRCCS San Raffaele Scientific Institute, Milan, Ital
    Issue Date
    2022
    
    Metadata
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    Abstract
    Background and aims: Patients with early-onset colorectal cancer (eoCRC) are managed according to guidelines that are not age-specific. A multidisciplinary international group (DIRECt), comprised 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 employed 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. Based on 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.
    Citation
    Cavestro Giulia M, Mannucci A, Balaguer F, Hampel H, Kupfer SS, Repici A, et al. Delphi initiative for early-onset colorectal cancer (DIRECt). International Management Guidelines. Clinical gastroenterology and hepatology : the official clinical practice journal of the American Gastroenterological Association. 2022 Dec 19. PubMed PMID: 36549470. Epub 2022/12/23. eng.
    Journal
    Clinical Gastroenterology and Hepatology
    URI
    http://hdl.handle.net/10541/625928
    DOI
    10.1016/j.cgh.2022.12.006
    PubMed ID
    36549470
    Additional Links
    https://dx.doi.org/10.1016/j.cgh.2022.12.006
    Type
    Article
    Language
    en
    ae974a485f413a2113503eed53cd6c53
    10.1016/j.cgh.2022.12.006
    Scopus Count
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    All Paterson Institute for Cancer Research

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