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 starting with chemoradiation for a faster response?
Answer from: Radiation Oncologist at Academic Institution
I personally favor starting with RT/chemo, but starting with chemo can work well. The more important issue is the side questions. First, there is a huge difference between a lesion that is large and one that is nearly completely obstructing. Unfortunately, many endoscopists use the term "obstructing...
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Answer from: Medical Oncologist at Community Practice
Coming from the med-onc perspective, I agree with Dr. @Tepper's assessment of “obstruction” based on clinical symptoms while also trusting the discussion with the endoscopist. Personally, I prefer to start with chemotherapy. I can make individual adjustments to the regimen to prepare in ...
Answer from: Radiation Oncologist at Community Practice
At our center, we treat very advanced cases routinely. CRT or chemo can yield a worsening symptomatic obstruction. If symptomatic upfront or impending symptomatic, I think a diverting ostomy is the way to go. From there, I still prefer CRT upfront than chemo (but never mind if one or two cycles of c...
Answer from: Radiation Oncologist at Community Practice
Agree with the above. The obstructive symptoms will respond quickly in many patients with the institution of neoadjuvant treatment. However, it is not uncommon to have a patient who for various reasons does not seem to get started expeditiously on treatment. For those cases, referral for upfront div...
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Medical Oncologist at UH Seidman Cancer Center, Case Western Reserve University
Let's use our knowledge of high-school physics-Poi...
Let's use our knowledge of high-school physics-Poi...