Can pre-op chemoRT be used to potentially downstage an early stage rectal cancer (i.e. T2 N0) for a sphincter sparing operation?

It is certainly appropriate to consider pre-operative chemoRT in an early stage rectal cancer that would not otherwise require neoadjuvant chemoradiation.The goal here would be to convert the operation from one resulting in a permanent ostomy (APR) to one allowing sphincter sparing (LAR). Good data to support the ability of chemoradiation to convert patients to a sphincter sparing operation come from Sauer et al., NEJM 2004. This study asked each patient's surgeon whether the operation would all...

I do this if requested by the referring surgeon for tumors that would otherwise require an APR. A sprinter preservation advantage is a good enough reason but there is also a small (<10%) pelvic control benefit.

Interesting issue...Here is how I address it:

There are basically "3 margins" from a surgical standpoint:
- The superior margin is virtually never an issue.
- The lateral margins: this is what the surgeons love to talk about: T.M.E.
- The inferior margin: this is the crux of this question.

There will be 3 scenarios:
- C.R. (complete response): the current debate is whether to perform surgery on C.R. pts. I will leave this up to the surgeon re observation vs surgery. The C.R. rate is about 25-35% in ...

As @Dr. First Last mentioned, you've got to get the referral from a surgeon who would even mentally countenance chemoRT for a T2 rectal CA (and not to try some sort of non-APR, transanal approach to boot). But I'd say yes to the question re: sphincter sparing. Of course the most "sparing" treatment option possible is going to be complete organ sparing (i.e. no surgery or just local excision). There's provocative data in this regard going back for a while now (1). It's being actively studied and ...