Rectal Cancer&nbsp;&nbsp;&nbsp;

Have the final results of the OPERA trial changed the way you approach organ preservation in rectal cancer?

Are you more inclined to offer brachytherapy boost instead of EBRT boost?

What are your top takeaways in GI Cancers from ASTRO 2024?

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...

What is your approach to TNT sequencing for locally advanced rectal primaries with low volume metastatic disease to liver?

How would you treat an MMR-proficient T2 N0 low-rectal cancer (measuring 2 cm extending 4-6 cm from the anal verge) in a patient who wishes to preserve his sphincter?

Is there data on neoadjuvant chemo-RT or chemo in this setting?

When treating a high rectal cancer, does your coverage of the caudal mesorectum depend on the surgical plan?

How do you construct the caudal extent of your volume - for example, pelvic floor via RTOG/international consensus vs 4 cm below gross disease via RAP...

Are you using vaginal dilators during treatment of rectal cancer to spare anterior vaginal wall, or are you reserving this for anal cancers?

What target volumes do you use for rectosigmoid/very superior rectal cancers?

Does it ever differ from a standard rectal field? For example, do you always treat the entire rectum, mesorectum, and entire length of internal iliac ...

How would you adjust your CTV for a locally advanced rectal cancer case with invasion of the prostate?

Would you cover the entire prostate?

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?

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...

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

Would you include the entire bladder in the treatment field of a patient with a history of T1 bladder cancer s/p intravesical therapy who is now being planned for chemoradiation for a T3N1 rectal cancer?

Intravesical therapy was delivered two years prior, and last cystoscopy was negative. One-third of the bladder would otherwise be included in the plan...

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

When treating rectal cancer with neoadjuvant chemoRT, is it appropriate to employ IMRT planning, rather than 3D conformal, for all cases, or should IMRT be reserved for special circumstances?

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?

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.

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

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

Would you offer treatment according to the PROSPECT trial for rectal cancer in which an involved lymph node approaches the circumferential resection margin (CRM)?

Consider a patient who prioritizes fertility preservation, for whom one of three suspicious nodes approaches the CRM, and is <1 mm from the mesorec...

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...

Should we be shrinking rectal cancer fields?

With trials like PROSPECT and FOWARC showing no statistically significant improvement in locoregional control and survival outcomes when comparing rad...

Is there a scenario in which you would consider neoadjuvant radiation for rectal cancer after previous definitive radiation for prostate cancer?

Especially consider a situation where surgical excision alone is not appropriate. What if the radiation was LDR or HDR brachytherapy?

For what patients are you adopting the PROSPECT approach into your rectal cancer practice?

How are you approaching patients with rectal cancer who meet PROSPECT criteria but have other higher risk features, such as >4 lymph nodes with sus...

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

6 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?

For patients undergoing TNT for rectal cancer with planned operative management, what is the optimal sequencing and timing of workup imaging and procedures?

Do you have a preference in ordering MRI, endoscopy, CT scan (chest, abdomen, pelvis), EUS, or other testing before starting any treatment, for re-sta...

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?

0 Answers 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?

Would you alter radiation recommendations for a patient with locally advanced rectal cancer and a history of abdominopelvic lymphoma radiation 40 years ago?

Would the location of the tumor (i.e. ultralow), symptoms (bleeding), or patient resistance to surgery play into this decision?

In a patient with rectal adenocarcinoma and involved gluteal lymph nodes, what would your elective lymph node volume include?

Would this change if the cancer was p16+ squamous cell carcinoma?

How would you approach consolidative rectal irradiation for a patient with liver-confined metastatic rectal adenocarcinoma, who has sustained a near-CR after CAPEOX, capecitabine, and ongoing bevacizumab?

The patient has sustained a positive response for >1 year after diagnosis.

How would you treat synchronous high-risk prostate and rectal adenocarcinomas in an elderly man where the rectal cancer was resected secondary to obstruction (T3N0)?

How would you sequence therapy, and what dose and volumes would you use for radiation? Prostate cancer is localized, Gleason 4+3, PSA 65.

Would you offer post-operative radiation for a T2N0 rectal cancer with less than 12 lymph nodes found in the specimen after LAR?

What is the preferred palliative regimen for elderly patients with rectal cancer who elect to forego surgery?

Is concurrent chemoradiation reasonable or excessive in a patient with life expectancy <5 yrs? Should the standard be 5 Gy x 5, and will this provi...

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?

Are there select patients with rectal cancer where radiation field size reduction might be feasible?

Do you ever utilize short-course radiation when lateral pelvic (extra-mesorectal) lymph nodes are involved?

Would you boost involved lateral pelvic lymph nodes in this scenario?

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

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

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...

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...

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?

What dose/fractionation would you offer a non-operable patient with a low-lying T2N0 rectal cancer in the setting of prior pelvic radiation >10 years ago?

If records have been destroyed, how do you factor prior pelvic radiation for prostate cancer into your decision?

Have you seen an increase in rectal spasms with short course vs long course radiation for rectal cancer?

How does your counseling about side-effects change when offering short vs long course radiation?

Would you ever omit adjuvant radiation for a patient with rectal cancer originally staged cT1N0, but found to be pT1N1 after surgery?

If the patient is amenable to adjuvant chemotherapy alone, but is worried about chronic diarrhea/urgency after radiation, how would you counsel them?

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...

Would you offer palliative re-irradiation to the sacrum for a patient with a prior history of RT for rectal cancer?

The patient has disease in the S2/S3 region with an anterior soft tissue mass. The patient previously received 50.4 Gy with treatment for rectal canc...

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

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

Any adjustments in terms of elective nodal coverage?

In which clinical scenarios would you prefer to sequence chemotherapy prior to radiation therapy in total neoadjuvant therapy for locally advanced rectal cancer?

Are there clinical scenarios in which you have found chemotherapy first has been beneficial? (i.e., advanced T stage, extra-mesorectal LN, anat...

For patients receiving TNT for locally advanced rectal cancer who have received chemotherapy prior to chemoradiotherapy, do you treat the pre or post-chemotherapy volume for the boost, especially in patients who have had a near complete response?

Is extramural venous invasion (EMVI) alone an indication to treat rectal cancer patients with total neoadjuvant therapy as opposed to neoadjuvant chemoradiation therapy or short course radiation therapy alone?

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?

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...

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

Do you have a size criteria when treating lung oligometastases with SBRT?

Would you consider treating 3-5mm lesions with SBRT or wait until they are a certain size? I am concerned I will not be able to see them adequately on...

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?

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?

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...

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...