"Evaluating Current Diagnostic and Treatment Challenges in Colorectal Cancer: Strategies for improving care and outcomes in Georgia".

Purpose: An initial analysis of population-based cancer survival data from Georgia revealed lower CRC survival rates compared to high-income countries. We conducted the study to address this issue and propose strategies for enhancing CRC care.

Patients And Methods: We analyzed CRC statistics, reviewed screening programs, and examined published CRC research in Georgia. Finally, we surveyed 16 oncologists from major institutions all over the country to assess molecular testing, treatment standards, and access to modern medications.

Results: Despite CRC screening being available in Georgia, late diagnoses persist, with over a 1/3 of cases presenting with acute intestinal obstruction. As a result, 65 % of CRC patients are diagnosed at locally advanced or metastatic stages. All 16 oncologists reported limited molecular testing due to costs, with 13 not routinely performing MSI/MMR and NRAS/KRAS/BRAF testing. Consequently, only 15 % of patients receive anti-EGFR therapy. Oxaliplatin-based therapy is almost universally used for metastatic CRC as the first-line treatment. No CRC clinical trials have been conducted in Georgia over the past three years. Treatment for locally advanced rectalcancer typically includes chemoradiotherapy followed by surgery, with notable variation in multidisciplinary team meeting practices.

Conclusions: Study provides several practical recommendations: it is crucial to promote CRC screening programs, enhance access to modern treatment options, and standardize national diagnostic/treatment protocols. There is an urgent need for more clinical trials to increase access to modern therapeutics, as well as to strengthen MDT meetings. These measures are expected to improve CRC care with a further reduction in CRC mortality rates.