How do you manage persistent rectal bleeding in the setting of rectal adenocarcinoma in a treatment-naive patient?

For a locally advanced rectal adenocarcinoma in the era of TNT, treatment of the tumor with either chemoradiation or chemotherapy upfront is reasonable, and both choices are known to palliate colorectal cancers effectively. With more severe bleeding, we often consider starting with chemoradiation therapy, which may have more rapid hemostatic properties than chemotherapy alone and has a well-proven track record of being quite effective at palliating tumor-related bleeding.

The most convincing data in support of palliative RT for bleeding GI tumors is for gastric cancer, where there is a large body of literature on the efficacy of RT as a palliative approach to control bleeding, with success rates in the 80-90%+ range.

Discrete PROs about the e...