Multidisciplinary Evaluation and Treatment: Evolution to Standard Clinical Practice

Combined-modality therapy integrating chemotherapy with radiotherapy and/or surgery is playing an increasing role in the day-to-day management of a wide variety of solid tumors. No longer is this approach solely a clinical research tool. In fact, in many clinical settings, combined-modality therapy is now the standard of care.

Concomitantly, the paradigm for evaluating cancer patients has shifted from a single practitioner representing a single discipline or modality to multidisciplinary evaluation and management teams that integrate the expertise and treatment skills of surgeons, radiation oncologists, and medical oncologists. In both academic and community settings, multidisciplinary clinics in which patients are evaluated using this team approach are increasingly employed. This approach facilitates and expedites appropriate staging, entry into clinical trials, and everyday patient care. In general, patients appreciate this opportunity to obtain both multiple opinions and consensus regarding treatment-planning issues.

The rationale for combined-modality therapy is twofold: optimizing local tumor control by the use of local modalities, ie, surgery or radiotherapy, while addressing both locally advanced primary tumors and distant micrometastases with the use of systemic chemotherapy. A number of different approaches integrate chemotherapy with local therapy: chemotherapy can precede local therapy (induction or neoadjuvant), be given concurrently, or follow local therapy (adjuvant). For many tumor types, the optimal combination of modalities and their sequence remains to be defined. Yet evidence is emerging in a variety of clinical settings that a combination of local therapy plus systemic chemotherapy results in an outcome superior to that of either local modality alone.

In this symposium, leading investigators in combined-modality therapy describe recent advances in their respective areas. Although considerable differences exist depending on tumor type and combined-modality regimen employed, common themes of improved local control, reduction in distant metastases, and improved organ function or preservation are present. The following presentations not only define the current status of combined-modality therapy but also point to future directions in this area of clinical research and clinical practice.