In patients undergoing pre-operative chemoradiation for rectal adenocarcinoma with clinically positive pelvic sidewall nodes that may not be surgically accessible, do you boost these nodes above 50.4 Gy?

I use IMRT with a simultaneous integrated boost to 62.5Gy or 70Gy to lateral pelvic, non-TME nodes that are greater than 5 mm on MRI. I use 70Gy when I can spare the sciatic nerve and the ureter, otherwise 62.5Gy /25 fx (the low pelvis receives 50Gy).

I always asked the surgeons if they plan to remo...