How do you manage patients with low-lying rectal adenocarcinoma who refuse surgery?

There is no simple answer to this question. There is a long history of patients being treated primarily with radiation therapy, but the interest has been much greater in the past few years with the publication of the Brazilian and other data. First, a word of caution regarding this paper in that the patients treated without surgery appear to be a highly selected group with relatively small and low stage tumors. I don't think that these results can be extrapolated to the usual patient we see in radiation oncology with large T3 tumors. Second, these investigators used Tegafur as the chemotherapy which is not available in the US. Third, I was not able to find the appendix to determine how they delivered the 5 Gy brachy boost, but that informat...