How would you manage a patient with synchronous locally advanced rectal adenocarcinoma (T3N2) and a large T2N0 adenocarcinoma of mid and distal esophagus?

A tough situation no doubt. Def need an MDT agreement with medical oncology and surgery. The patient should be evaluated for surgical (especially esophageal resectability).

I am going to try to be creative here :

I would vote 5x5 to rectal mass then get on mFOLFOX6 based chemo per CALGB 80803 trial...

Preop ChemoRT for both if tolerable.

It's tempting to try to squeeze chemoradiotherapy when we have 2 tumor areas but it will be too complex for likely marginal advantage.

Few things to keep in mind:

• We make sure genomics are done and nothing interesting.
• Rectal seems more advanced than esophageal. So tailoring therapy for rectal makes...