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Abstract
Background: Despite the extensive implementation of an organized multidisciplinary team (MDT) approach in cancer treatment, there is little evidence regarding the optimal format of MDT. We aimed to investigate the impact of patient participation in MDT care on the actual application rate of metastasis-directed local therapy.

Methods: We identified all 1211 patients with locally advanced rectal cancer treated with neoadjuvant radiochemotherapy at a single institution from 2006 to 2018. Practice patterns, tumor burden and OMD state were analyzed in recurrent, metastatic cases.

Results: With a median follow-up of 60.7 months, 281 patients developed metastases, and 96 (34.2%), 92 (32.7%), and 93 (33.1%) patients had 1, 2-5, and >5 lesions, respectively. In our study, 27.1% were managed in the MDT clinic that mandated the participation of at least four to five board-certified multidisciplinary experts and patients in decision-making processes, while the rest were managed through diverse MDT approaches such as conferences, tumor board meetings, and discussions conducted via phone calls or email. Management in MDT clinic was significantly associated with more use of radiotherapy (p = 0.003) and more sessions of local therapy (p < 0.001). At the time of MDT clinic, the number of lesions was 1, 2-5, and >5 in 9 (13.6%), 35 (53.1%), and 19 (28.8%) patients, respectively. The most common states were repeat OMD (28.8%) and de novo OMD (27.3%), followed by oligoprogression (15%) and induced OMD (10.6%).

Conclusion: Our findings suggest that active involvement of patients and radiation oncologists, and surgeons in MDT care has boosted the probability of using local therapies for various types of OMD throughout the course of the disease.

Affiliations

Seo Hee Choi 1, Gowoon Yang 1, Woong Sub Koom 1, Seung Yoon Yang 2, Seung-Seob Kim 3, Joon Seok Lim 3, Han Sang Kim 4, Sang Joon Shin 4, Jee Suk Chang 1
1Department of Radiation Oncology, Yonsei University College of Medicine, Seoul, Korea.
2Department of Surgery, Yonsei University College of Medicine, Seoul, Korea.
3Department of Radiology, Yonsei University College of Medicine, Seoul, Korea.
4Division of Medical Oncology, Department of Internal Medicine, Yonsei University College of Medicine, Seoul, Korea.