What treatment sequence do you follow for patients with rectal cancer who are candidates for both PROSPECT and TNT/Watch and wait?

Thanks for this question. I am not sure whether this is up to us. This is up to our patients to choose which modality they would like to omit (radiation vs surgery). I would point out that a good quality MRI rectum should be performed to r/o any T4/N2 disease or potential requirement for APR. Otherw...

In addition to the above responses, which I agree with, I would also like to add that the addition of brachytherapy significantly improves the CR for patients aiming for non-operative management.

We have publications of OPERA and MORPHEUS trials that have demonstrated the benefit of brachytherapy, a...

I mostly use TNT followed by selective surgery per OPRA. Patients with locally advanced rectal cancer (stage II and III) are eligible regardless of tumor location in the rectum.

With regards to PROSPECT, T4 and/or N2 tumors were excluded. The tumor had to be 5-12 cm from the dentate line (lower recta...

The big difference between these approaches is the ability to do organ preservation. If organ preservation is a goal, PROSPECT is out. If the patient is clear about getting TME, then PROSPECT is very reasonable to get the potential to avoid late RT toxicities.

The ASCO guidelines for management of locally advanced rectal cancer perform a meta-analysis showing TNT improves 5-year OS compared to neoadjuvant CRT (Table 3).

If PROSPECT shows equivalent OS between neoadjuvant CRT and neoadjuvant chemo, then a reasonable conclusion to draw is that a TNT approach...