What is your typical target/field when treating a patient with 5 Gy x 5 fractions pre-operatively for rectal cancer?

The European experience with short course preoperative radiotherapy uses treatment portals that are somewhat smaller than what many of us utilize in the US. At Washington University we have a long experience (that pre-dates the Swedish trials) with 4Gy X 5fx for readily resectable tumors. The cases selected for this regimen underwent surgery within a few days of completing RT. The majority of our patients were not treated this way, the majority were given long course RT with delayed surgery beca...

I have used this same preop approach for mid and high rectal tumors (when I don't have to cover the anal sphincter) IMRT with 20 Gy to elective areas/25 Gy to tumor PTV in 5 fractions. I agree, use caution and avoid large volume to 25 Gy. Great question!