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Radiation Oncology • Gastrointestinal Cancers
How would you approach neoadjuvant radiation therapy for an adenocarcinoma of the anus involving the perirectal skin in a patient with a history of total proctocolectomy with an ileoanal J-pouch anastomosis?
Surgery has recommended against up-front diversion in order to avoid treatment delays. The patient has at least one suspicious internal iliac lymph node. Would you reduce your pelvic volume or boost volume due to the anastomosis?
Answer from: Radiation Oncologist at Academic Institution
I think it is likely that this is a patient with UC. The fact that this is an adenocarcinoma and that it involves the peri-anal skin with a possible positive iliac node means that there is no possibility of preserving the sphincter using surgery. The tumor is likely arising in the residual bowel and...
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Answer from: Radiation Oncologist at Academic Institution
When treating adenocarcinoma of the anus in a patient with a history of total proctocolectomy with an ileoanal J-pouch anastomosis due to ulcerative colitis, it is essential to consider the potential risks and benefits of neoadjuvant radiation therapy carefully. I may recommend TNT.
In this case, r...
Answer from: Radiation Oncologist at Academic Institution
With an adenocarcinoma involving the anus and perirectal skin, likely this patient would need an APR and permanent ileostomy after neoadjuvant treatment. I suppose there is a chance they could have a complete clinical response but this case seems like a pretty aggressive cancer so I wouldn't expect ...