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 C...

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 recta...