Should we be shrinking rectal cancer fields?

Topics: Radiation Oncology • Gastrointestinal Cancers • Rectal Cancer

With trials like PROSPECT and FOWARC showing no statistically significant improvement in locoregional control and survival outcomes when comparing radiation-containing neoadjuvant treatment to chemotherapy alone, are we moving towards the elimination of elective nodal irradiation in the pelvis?

Answer from: Radiation Oncologist at Academic Institution

I think this is a good point. However, I think we need to consider the nuances of the question. First PROSPECT included: patients that "had cT2N+, cT3N-, cT3N+ rectal cancers deemed appropriate for neoadjuvant therapy prior to low anterior resection with TME. Patients with distal, T4 tumors, threate...

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Radiation Oncologist at Washington University School of Medicine
The 1 cm margin at the posterior bladder wall is i...

Answer from: Radiation Oncologist at Community Practice

Definitely agree with all the points made above for and against shrinking fields. I believe it's appropriate to think about shrinking fields especially with publications of OPERA results (Gerard et al., PMID 36801007), that with the addition of brachytherapy, one can achieve a significantly hig...

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