For 2007, UMED ventured on its first ever out of the country State-of-the-Art conference in Macau, a city of churches, fortresses and a self styled Las Vegas of the East. Located in the southern coast of China, it provided an idyllic venue for the country’s First Multidisciplinary Colorectal Cancer Conference. Held in Hotel Lisboa at the heart of Macau’s downtown area, the meeting highlighted the important issues and concerns of the Philippine medical oncology experts. An outcome of a series of meetings with UMED, Biomedis-Oncology, UMED Board of Advisers for Oncology and a conference steering committee, the scientific program was aimed to address the controversial issues in the treatment of colon and rectal cancers and discuss the appropriate multidisciplinary approach to such ailments. The conference was conducted with utmost objectivity. The Philippine Medical Association (PMA) and Philippine College of Physicians (PCP) duly recognized this and accredited it with 36 and 10 CME units respectively, a first for an overseas conducted conference in the local pharmaceutical industry. Similar to last year’s Cebu Breast Cancer Conference, this meeting was a gathering of more than 145 key opinion leaders that was marked by a very comprehensive approach on the current issues concerning colorectal cancer staging, planning, and treatment.
Colorectal cancer is the third most common cancer in both men and women. In 2003, nearly 150,000 cases of colon and rectal cancer were diagnosed and more than 57,000 people died from the disease, accounting for about 10% of all cancer deaths. Tremendous strides are made regularly in the prevention, diagnosis, and treatment of this disease, posing a challenge to the clinician who must stay abreast of the most recent advances. It is this milieu that bore strong influence to the approach by which the scientific program of the SOA conference was designed for this May 6 activity. Dr. Edward Lin, a foremost authority in oncology and an associate professor from University of Washington, USA, was the special guest faculty. 19 other local experts and recognized authorities comprised the panel of speakers.
UMED Executive Director , Dr. Edgardo Ortiz, opened the meeting with a prayer and short speech that acknowledged the efforts of all people working behind the scene. Special recognitions were given to the Board of Advisers for Oncology – Drs. Antonio Villalon, Priscilla Caguioa, Valorie Chan, Dennis Tudtud, Jasmin Igama, and steering committee members Drs. Gerardo Cornelio, Beatrice Tiangco, Manuel Francisco Roxas and Eugene Regala. Throughout the meeting, Dr. Ortiz and his staff were “hands on” in monitoring the flow of activities. First to stand in the podium for his talk on “Endoscopic Ultrasound (EUS) as a Diagnostic Tool for Early Colorectal Cancer” was Dr. Frederick Dy. He discussed in detail the role of EUS in locoregional staging. This diagnostic procedure could distinctly differentiate the wall layers of the gastrointestinal tract. Unlike other imaging modalities, it could be performed at real-time and the biopsy of lymph node or suspicious lesions in the perirectal area could be performed in the same setting. Dr. Rosanna Fragante, on the other hand, discussed the use of multi-detector CT as a “one-stop shopping” modality advocated for nodal staging and evaluation of local staging for colorectal tumors. For lesions involving the pelvic floor, MRI was considered the best imaging method due to its high contrast resolution and multiplanar capabilities. Dr. Gaudencio Vega, in the next plenary session, answered the question on when radio adjuvant therapy would not be necessary for stage 2 rectal cancer. Dr. Edward Lin, as a follow-up, discussed the important issues involved in the need for adjuvant chemotherapy for patients with stage 2 colon cancer and emphasized that this form of treatment remains controversial given the lack of proof for survival. The next plenary session tackled the multidisciplinary treatment planning for locally advanced rectal cancer (LARC). The discussion of Dr. Teresita Sy-Ortin centered on the advantages, disadvantages of short course (25Gyx5 fraction) vs. standard fractionation (50.4Gy/28 fractions) pre-op radiation for patients with rectal cancer. For his part, Dr. Edward Lin, elucidated on the key management points for patients with LARC: local control, systemic control and survival, quality of life (i.e. colostomy versus sphincter preservation) and toxicities and convenience of the treatment. His review showed that experienced centers and better staging techniques could lead to better clinical treatment outcomes. Randomized phase 3 studies had established the roles of preoperative radiation, post-operative chemoradiation and preoperative chemoradiation in the management of patients with LARC. Dr. Robert Chang talked about a surgical technique called total mesorectal excision (TME) as the key to minimize tumor recurrence. This technique involved sharp dissection within defined tissue planes to excise an intact, untorn specimen. To date, TME has been recognized as the gold standard in the surgical treatment of rectal cancer across Europe. Dr. Elizabeth Arcellana-Nuqui followed with a discussion on the appropriate pathologic evaluation of the rectal cancer specimen and its implications for prognosis and further treatment. Her talk clearly underscored the pathologist’s need to standardize gross and microscopic studies of colorectal specimens and likewise the acceptability and relevance of cancer grading system. The fourth plenary session was on the surgical and interventional management of colorectal cancer with liver metastasis. Dr. Catherine Teh remarked that surgery remains to be the treatment of choice for respectable liver metastases from colorectal cancer with an operative mortality of less than 5% and 5 year survival of as high as 50%. She, however, acknowledged the need for large prospective trials evaluating new treatment modalities to further improve the treatment outcome of liver metastases from colorectal cancer. Dr. Ramon Santos Ocampo, in his talk, stated that percutaneous, minimally invasive methods are available to treat metastatic lesions in patients with colorectal cancer. In smaller lesions 5 cm or less, radiofrequency ablation is a comparable alternative to surgical resection early in the patient’s course.
Three interactive case discussions from three medical centers – The Medical City, Manila Doctors Hospital and UST Hospital, were the focus of the afternoon’s sessions. Dr. Manuel Francisco Roxas discussed a case of a patient who presented as a annular polypoid mass lesion in the rectosigmoid area with pararectal and presacral fat infiltration and small lymphadenopathies. Drs. Karen Villanueva and Eugene Regala gave interesting discussions on colorectal cases with liver metastasis. What ensued was an interactive and interesting exchange of views on the diagnosis and management between the presenting team, the panel of expert and the participants. Dr. Gerardo Cornelio gave the over-all summary of the highlights of the discussions of this multidisciplinary conference. A very positive post conference assessment inclusive of evaluation of hotel accommodations, conference venue, out-of-conference activities and the high quality of plenary lectures and discussions, by and large, confirmed the huge success of this very important meeting as it achieved the goal of excellence and relevance in continuing medical education for the Filipino physician.