What dose and volume would be recommended for a medically inoperable patient with a T4 rectal adenocarcinoma?

As is so often true, there is no absolute answer to a general question of this sort. It is much less common nowadays for a patient to be medically inoperable with the major advances in anesthesia. That being said, these patients certainly do appear. There is not a good literature on the proper dose. However, in practice one needs to consider a few issues. First is whether there is metastatic disease and if so, its extent. If there are extensive metastases, I would not push the dose too high (but...

7 years after this answer, for a middle aged female with T4 anal canal adenocarcinoma due to sphincter and vaginal invasion, excellent PS and complete response, and good sphincter function following induction chemo who refuses APR, do we still agree with 60 Gy total dose? What is an appropriate GTV-->CTV expansion for the final boost? Any other planning recommendations? Should one consider Xeloda or infusional 5-FU, or another concurrent regimen, with a goal of maximizing cure and long term loca...