What is the best treatment approach for locally advanced (T3+ and/or N+) rectal cancer status post low anterior resection in a patient who has a remote history of seed implant for low risk prostate cancer?

These treatment decisions are best discussed within a multidisciplinary group. If the tumor is located on the anterior rectal wall and the prior high dose from the implant cannot be spared, there is a risk of rectal bleeding with re-irradiation if surgery is not performed and urinary fistula regardless of if surgery. This is generally true with any prior radiation >50Gy BED (so that includes GYN brachytherapy and high dose adjuvant prostate doses).

In the case of a posterior wall lesion, I use a...