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 chemotherapy or is surgery upfront the only way to answer this question?
Answer from: Radiation Oncologist at Community Practice
This is a somewhat common scenario. In these situations, I have strongly favored short course RT followed by immediate surgery such that there is not a sufficient time interval between RT and surgery to allow any significant pathologic response. I think you can be confident in that the pathology aft...
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Answer from: Radiation Oncologist at Academic Institution
To answer this question, I think it’s important to first note that, in the post RAPIDO era, a sequencing of modalities that puts adjunctive chemotherapy after surgery should be reserved for a small minority of cases. For unequivocal clinical stage II or III disease in medically fit patients, I...
Answer from: Medical Oncologist at Community Practice
While it allows for less treatment, as we move toward non operative therapy in complete responders, I think this will have limited applicability.