Do you treat rectosigmoid/upper rectal cancers with neoadjuvant chemoradiation?

The 12-year update to the phase III pre-op RT Dutch rectal trial found a local control benefit with RT regardless of location (VanGijn et al., Lancet Oncol. 2011; 12(6):575-82.). In the Dutch update, tumor location was analyzed as a continuous variable. This is different from the every 5 cm cut-offs...

If the tumor is high (> 12 cm) based on straight procto (not a flexible scope) I base the decision on the pelvic imaging. If it is in (part or whole) in the pelvis I add pelvic RT. For cT3N0, especially for a woman of childbearing age, I do give them the option of not receiving RT after a discussion...

This is an interesting question that comes up quite frequently in the clinic, and it's surprising to me that there hasn't been more dedicated literature on the topic. I agree with the above commenters that bulky/node-positive tumors and those with an intrapelvic location on imaging generally warrant...

First of all, I wouldn't NOT treat a cancer because it was rectosigmoid (double negative intended). If a tumor originates in the mid to upper pelvis, but is encroaching on vessels neighboring organs, it has as much need for aggressive preoperative treatments an advanced rectal cancer.

With rectosig...

This is a question that often comes up and in our experience, these cases are thoroughly discussed in MCC. Radiology review is absolutely necessary to define the tumor's relation, i.e. i) is it wholly or partly within the true pelvis ii) its relationship to APR iii) nodes iv) threatened margins.

It ...