Medical Oncology

Rectal Cancer

Questions discussed in this category

In what situations would you treat a rectal mass as cancer despite negative biopsies?

For example, if mass is ulcerated and cannot be excised with polypectomy? Would you ever consider radiation and chemotherapy?

4 Answers available

In which patients with early stage rectal cancer treated according to the PROSPECT paradigm do you recommend adjuvant chemotherapy?

Current NCCN guidelines do not include adjuvant chemotherapy for patients treated in this fashion; however, in the PROSPECT trial itself, an additiona...

4 Answers available

What is your approach to cT3N0M0 mid rectal adenocarcinoma with clear circumferential resection margins on MRI?

2 Answers available

For patients with large, partially or nearly obstructing rectal cancers, how do you sequence TNT in order to avoid complete obstruction and surgical diversion?

Do you find that starting with chemoradiation increases the risk of complete obstruction secondary to transient tumor inflammation, or do you favor st...

4 Answers available

For patients with locally advanced rectal cancer who desire organ preservation and can tolerate fluoropyrimidine but not oxaliplatin, what is the appropriate treatment approach?

2 Answers available

Would you recommend additional post-operative chemoradiation for a T2N1 proximal rectal cancer having received adjuvant capecitabine/oxaliplatin?

What factors might play into this decision?

3 Answers available

For a pedunculated rectal polyp found to be adenocarcinoma after endoscopic removal, with PNI as the only adverse feature, would you recommend additional treatment such as surgery or chemoradiation?

Consider some stalk invasion, but no deep submucosal extent and negative margins by 9 mm.

1 Answer available

How will the PROSPECT trial presented at ASCO 2023 change your current management of early rectal cancer?

Especially as the study was done before the adoption of total neoadjuvant therapy

3 Answers available

For patients with rectal cancer being treated along PROSPECT paradigm, would you extrapolate from the IDEA literature and offer 3 months of CAPOX neoadjuvantly, without adjuvant therapy?

1 Answer available

Would you offer neoadjuvant radiation therapy with concurrent chemotherapy for a T4 rectal carcinoma with an associated rectovesical fistula?

2 Answers available

How would you treat an elderly patient (ECOG 0-1) with locally advanced rectal cancer and synchronous Merkel cell cancer of the extremity requiring adjuvant RT?

Would you treat both at the same time? Does one need to be prioritized over the other? Does Xeloda have any efficacy against Merkel cell cancer? How...

4 Answers available

What are your top takeaways in GI Cancers from ASCO 2023?

7 Answers available

Would you recommend adjuvant capecitabine and radiation in addition to adjuvant FOLFOX for a patient with resected pT3N2 rectosigmoid adenocarcinoma with other high-risk pathologic features?

In general: when would you recommend adjuvant radiation and capecitabine for a colon cancer?

2 Answers available

How would you sequence treatment of a synchronous IC1 high-grade serous ovarian cancer and cT3N1 rectal cancer?

Since there is no overlap between chemo regimens for these cancers, how would you sequence treatment?

1 Answer available

How would you treat a synchronous low rectal adenocarcinoma and anal squamous cell carcinoma with involved pelvic and inguinal nodes?

What systemic therapy is most appropriate, how would you sequence, and what RT dose fractionation would you use?

6 Answers available

Would you offer adjuvant chemotherapy after SBRT for biopsy proven sub centimeter metastatic pulmonary nodule from rectal cancer?

1 Answer available

What is the recommended follow-up/surveillance schedule following organ preservation treatment approach for cT1-2N0 rectal cancer?

Taking into account follow up from NEO, OPERA and other organ preservation trials?

2 Answers available

How would you approach a T3N1M0 mid rectal cancer that is MMR deficient?

2 Answers available

Do you try to incorporate mFOLFIRINOX in total neoadjuvant therapy for rectal cancer?

Given the published results of the PRODIGE 23 trial where FOLFORINOX was used neoadjuvantly with FOLFOX post-op

2 Answers available

Is there a correlation between rectal cancer stage and dose response to radiotherapy?

Dose-escalation RT trials have had mixed results in the past for advanced rectal cancer, while in the early rectal stage there is a tendency towards a...

1 Answer available

For patients with cT1-T3 cN0 cM0 mid/low rectal cancer seeking organ preservation, what treatment approach do you recommend?

How do you weigh definitive chemoRT vs minimally invasive surgical approach with neoadjuvant chemo followed by transanal excision, in light of results...

2 Answers available

Would you be willing to give definitive chemo-radiation and chemotherapy to a MSI-stable T2N0 low lying rectal cancer in a young healthy patient who wants to avoid surgery?

Are you more likely to consider a trans-anal resection?

2 Answers available

For a rectal cancer with questionable T3 or questionable N+ by MRI, can short course radiation be given followed by surgery and the pathology still be interpreted to guide adjuvant chemotherapy?

I.E., can a patient with a questionable 5 mm node (MRI T2N1) which is negative on pathology after short course radiation be staged T2N0 and receive no...

3 Answers available

Would you consider upfront immunotherapy in a patient with MSI strongly positive locally advanced adenocarcinoma of the anus versus standard of care?

1 Answer available

Would you treat rectal squamous cell carcinoma the same as rectal adenocarcinoma, stage for stage?

Any adjustments in terms of elective nodal coverage?

4 Answers available

Would you recommend adjuvant chemotherapy for a patient who achieved a CR after TNT for stage III rectal adenocarcinoma but underwent no initial surgery, and now has a local recurrence >12 months later with plans to undergo low-anterior resection?

Total neoadjuvant therapy (TNT) included FOLFOX x 4 months and concurrent chemo-RT

1 Answer available

What is your approach to neoadjuvant chemotherapy for a T3N0 mid-rectal cancer?

1 Answer available

How would you approach the treatment of early stage rectal adenocarcinoma in patients with confirmed Lynch Syndrome?

Do you worry about fluoropyrimidine resistance with concurrent chemoRT? Is there any role for neoadjuvant immunotherapy?

2 Answers available

Would you offer additional adjuvant FOLFOX for patients with rectal CA undergoing TNT who transition to cape/RT and subsequent surgery early due to absence of clinical response to FOLFOX?

Would your decision be influenced by whether a pathologic complete response was attained?

1 Answer available

For locally advanced rectal cancer, would you consider utilizing the RAPIDO trial approach of short course radiation followed by neoadjuvant chemotherapy prior to surgery?

Colleagues in surgery have raised concerns about post radiation effects in the pelvis with the ordering of short course RT->chemo ->surgery.

5 Answers available

How would you manage early-stage low rectal cancer in a patient unable or unwilling to undergo surgery?

3 Answers available

Would you consider adding HER2 targeted treatment to chemotherapy for a patient with locally advanced, HER2+ rectal cancer who is going to have total neoadjuvant treatment?

3 Answers available

What is the preferred number of cycles of CAPOX for rectal cancer receiving total neoadjuvant chemotherapy?

2 Answers available

How do you sequence short course radiation for locally advanced rectal cancer when using the total neoadjuvant approach?

When using short course RT, the NCCN guidelines currently recommend short course RT followed by chemotherapy, followed by surgery. Many surgeons are h...

4 Answers available

When do you consider total neoadjuvant therapy (chemotherapy and chemoradiation) for rectal cancer?

1 Answer available

When would you consider initial induction chemotherapy (e.g. FOLFOX) followed by neoadjuvant chemoradiation, over neoadjuvant chemoradiation alone, in patients with locally advanced rectal cancer?

1 Answer available

Which patients would you offer a watch-and-wait approach versus surgical resection after chemoradiotherapy for patients with rectal cancer?

5 Answers available

For rectal cancer with solitary liver metastasis, do you recommend neoadjuvant chemoradiation?

Are these patients better candidates for preop chemotherapy alone?

2 Answers available

How do you approach disease monitoring in patients with localized rectal cancer who have received treatment with chemoradiation?

Is MRI being considered the primary mode of imaging in multidisciplinary tumor boards, especially in light of the results of the MERCURY trial (JCO 20...

1 Answer available

Should capecitabine be administered at a specific time prior to RT in pre-op chemoradiation treatment for rectal cancer?

Would taking the drug at a specific time point prior to their radiation appointment time to maximize blood levels of the drug be clinically beneficial...

1 Answer available

Papers discussed in this category

Lancet Oncol., 2015 Dec 16

Watch-and-wait approach versus surgical resection after chemoradiotherapy for patients with rectal cancer (the OnCoRe project): a propensity-score matched cohort analysis.

Lancet,

Long-term outcomes of clinical complete responders after neoadjuvant treatment for rectal cancer in the International Watch & Wait Database (IWWD): an international multicentre registry study.

Gastrointestinal cancer research : GCR, 2007-03

Capecitabine and timing of radiotherapy during preoperative chemoradiation for rectal cancer.

Journal of the National Comprehensive Cancer Network : JNCCN, 2014-04

Neoadjuvant chemotherapy first, followed by chemoradiation and then surgery, in the management of locally advanced rectal cancer.

Cancer medicine, 2016-12

Comparison of outcomes between rectal squamous cell carcinoma and adenocarcinoma.

Clinics in colon and rectal surgery, 2012-06

Oncologic management of hereditary colorectal cancer.

Eur J Gastroenterol Hepatol,

Effect of radiation therapy on the potential doubling time of tumours in colorectal cancers.

The Lancet. Oncology, 2015-08

Effect of adding mFOLFOX6 after neoadjuvant chemoradiation in locally advanced rectal cancer: a multicentre, phase 2 trial.

Radiother Oncol, 2020 Mar 30

Compliance and tolerability of short-course radiotherapy followed by preoperative chemotherapy and surgery for high-risk rectal cancer - Results of the international randomized RAPIDO-trial.

Ann. Surg., 2020 Mar 20

Perioperative Complications After Proctectomy for Rectal Cancer: Does Neoadjuvant Regimen Matter?

Lancet Oncol., 2017-03-01

Optimal fractionation of preoperative radiotherapy and timing to surgery for rectal cancer (Stockholm III): a multicentre, randomised, non-blinded, phase 3, non-inferiority trial.

Adv Radiat Oncol, 2020 Apr 22

Management of Locally Advanced Rectal Cancer During The COVID-19 Pandemic: A Necessary Paradigm Change at Memorial Sloan Kettering Cancer Center.

Lancet Oncol, 2020 Dec 07

Short-course radiotherapy followed by chemotherapy before total mesorectal excision (TME) versus preoperative chemoradiotherapy, TME, and optional adjuvant chemotherapy in locally advanced rectal cancer (RAPIDO): a randomised, open-label, phase 3 trial.

Ann Oncol,

Rectal cancer: ESMO Clinical Practice Guidelines for diagnosis, treatment and follow-up.

Lancet Oncol, 2021 Apr 13

Neoadjuvant chemotherapy with FOLFIRINOX and preoperative chemoradiotherapy for patients with locally advanced rectal cancer (UNICANCER-PRODIGE 23): a multicentre, randomised, open-label, phase 3 trial.

N Engl J Med, 2018 Mar 29

Duration of Adjuvant Chemotherapy for Stage III Colon Cancer.

J. Clin. Oncol., 2019 Oct 08

Oxaliplatin-Based Adjuvant Chemotherapy for Rectal Cancer After Preoperative Chemoradiotherapy (ADORE): Long-Term Results of a Randomized Controlled Trial.

Lancet Oncol., 2016-06-01

Dual-targeted therapy with trastuzumab and lapatinib in treatment-refractory, KRAS codon 12/13 wild-type, HER2-positive metastatic colorectal cancer (HERACLES): a proof-of-concept, multicentre, open-label, phase 2 trial.

The Lancet. Oncology, 2019-04

Pertuzumab plus trastuzumab for HER2-amplified metastatic colorectal cancer (MyPathway): an updated report from a multicentre, open-label, phase 2a, multiple basket study.

J Natl Cancer Inst,

Molecular Landscape of ERBB2/ERBB3 Mutated Colorectal Cancer.

Lancet Oncol, 2021 May 04

Trastuzumab deruxtecan (DS-8201) in patients with HER2-expressing metastatic colorectal cancer (DESTINY-CRC01): a multicentre, open-label, phase 2 trial.

Int J Radiat Oncol Biol Phys, 2019 Dec 1

Executive Summary of the American Radium Society Appropriate Use Criteria for Local Excision in Rectal Cancer.

Pract Radiat Oncol, 2020 Oct 21

Radiation Therapy for Rectal Cancer: Executive Summary of an ASTRO Clinical Practice Guideline.

International journal of radiation oncology, biology, physics, 1988-02

Endocavitary irradiation for rectal cancer and villous adenomas.

Lancet Oncol,

Effect of duration of adjuvant chemotherapy for patients with stage III colon cancer (IDEA collaboration): final results from a prospective, pooled analysis of six randomised, phase 3 trials.

World J Gastroenterol,

Adjuvant chemotherapy for resected colorectal cancer metastases: Literature review and meta-analysis.

Lancet Oncol., 2011 May 17

Preoperative radiotherapy combined with total mesorectal excision for resectable rectal cancer: 12-year follow-up of the multicentre, randomised controlled TME trial.

International journal of radiation oncology, biology, physics, 1999-02-01

Five fractions of preoperative radiotherapy for selected cases of rectal carcinoma: long-term tumor control and tolerance to treatment.

J Clin Oncol,

Swedish Rectal Cancer Trial: long lasting benefits from radiotherapy on survival and local recurrence rate.

N Engl J Med, 2022 Jun 05

PD-1 Blockade in Mismatch Repair-Deficient, Locally Advanced Rectal Cancer.

J Clin Oncol, 2022 Apr 28

Organ Preservation in Patients With Rectal Adenocarcinoma Treated With Total Neoadjuvant Therapy.

N Engl J Med, 2022 Nov 03

Prevalence of Mismatch-Repair Deficiency in Rectal Adenocarcinomas.

Clinical cancer research : an official journal of the American Association for Cancer Research, 2018-05-01

Merkel Cell Carcinoma in the Age of Immunotherapy: Facts and Hopes.

Asia-Pacific journal of clinical oncology, 2020 Aug 05

The changing paradigm of managing Merkel cell carcinoma in Australia: An expert commentary.

Annals of surgical oncology, 2020 May 13

Patterns of Metastasis in Merkel Cell Carcinoma.

Diseases of the colon and rectum, 2019 Jun

Organ Preservation Among Patients With Clinically Node-Positive Rectal Cancer: Is It Really More Dangerous?

J Clin Oncol, 2022 Aug 18

Neoadjuvant Chemotherapy, Excision, and Observation for Early Rectal Cancer: The Phase II NEO Trial (CCTG CO.28) Primary End Point Results.

JAMA Surg, 2019 Jan 01

Long-term Oncological and Functional Outcomes of Chemoradiotherapy Followed by Organ-Sparing Transanal Endoscopic Microsurgery for Distal Rectal Cancer: The CARTS Study.

The Lancet. Oncology, 2015-11

Organ preservation for clinical T2N0 distal rectal cancer using neoadjuvant chemoradiotherapy and local excision (ACOSOG Z6041): results of an open-label, single-arm, multi-institutional, phase 2 trial.

Int J Radiat Oncol Biol Phys, 2012 Jul 03

Radiation dose-response model for locally advanced rectal cancer after preoperative chemoradiation therapy.

Oncology, 2022 Oct 28

Clinical T2N0 Rectal Cancer Treated with Neoadjuvant Chemoradiotherapy plus Local Excision.

J Clin Oncol, 2019 Sep 26

Neoadjuvant Modified FOLFOX6 With or Without Radiation Versus Fluorouracil Plus Radiation for Locally Advanced Rectal Cancer: Final Results of the Chinese FOWARC Trial.

Ann Surg, 2023 Jan 20

Locoregional Failure During and After Short-course Radiotherapy followed by Chemotherapy and Surgery Compared to Long-course Chemoradiotherapy and Surgery - A Five-year Follow-up of the RAPIDO Trial.

Ann Oncol, 2022 Oct 25

Metastatic colorectal cancer: ESMO Clinical Practice Guideline for diagnosis, treatment and follow-up.

J Clin Oncol, 2023 Jun 04

Patient-Reported Outcomes During and After Treatment for Locally Advanced Rectal Cancer in the PROSPECT Trial (Alliance N1048).

N Engl J Med, 2023 Jun 04

Preoperative Treatment of Locally Advanced Rectal Cancer.

N. Engl. J. Med., 2004-10-21

Preoperative versus postoperative chemoradiotherapy for rectal cancer.

JAMA oncology, 2018-06-14

Adoption of Total Neoadjuvant Therapy for Locally Advanced Rectal Cancer.

Ann Surg, 2020 Mar

Total Neoadjuvant Therapy in Rectal Cancer: A Systematic Review and Meta-analysis of Treatment Outcomes.

Lancet Oncol, 2023 Jun 02

Zanidatamab for HER2-amplified, unresectable, locally advanced or metastatic biliary tract cancer (HERIZON-BTC-01): a multicentre, single-arm, phase 2b study.

N. Engl. J. Med.,

FOLFIRINOX or Gemcitabine as Adjuvant Therapy for Pancreatic Cancer.

Frontiers in oncology, 2023 Jun 29

Risk-adjusted chemoradiation according to human papilloma viral status for anal cancer: a pilot study.

European journal of surgical oncology : the journal of the European Society of Surgical Oncology and the British Association of Surgical Oncology, 2021 Dec 20

Rectal cancer with synchronous inguinal lymph node metastasis without distant metastasis. A call for further oncological evaluation.

Colorectal disease : the official journal of the Association of Coloproctology of Great Britain and Ireland, 2010 Oct

Inguinal lymph node metastases are recognized with high frequency in rectal adenocarcinoma invading the dentate line. The histological features at the invasive front may predict inguinal lymph node metastasis.

Cancer medicine, 2018-12

Squamous cell carcinoma of the rectum: Practice trends and patient survival.

Oncology (Williston Park, N.Y.), 2018-01-15

Woman With Rare Cause of Rectal Bleeding.

Frontiers in oncology, 2023 Jun 08

Case report of unusual synchronous anal and rectal squamous cell carcinoma: clinical and therapeutic lesson.

The American surgeon, 2015 May

The impact of surgical diversion before neoadjuvant therapy for rectal cancer.

Lancet (London, England), 2009-03-07