Would you offer adjuvant chemoRT for node positive high rectal cancer above the peritoneal reflection?

I would not offer RT to this patient. If you look at the data, the risk of local recurrence of rectal cancer decreases dramatically as the distance from the anal verge increases, and with proper surgery, is well under 5% (probably 1-2%) for tumors above 10 cm. It is not even clear that the tumor described is a rectal, and not a colon, cancer and this patient will have a recurrence pattern as for colon cancer. When the tumor is above the reflection there is a serosa present and issues such as cir...

Decisions regarding whether preoperative chemoradiation would be appropriate to recommend are dependent on T category of disease which is not stated. If preoperative imaging demonstrated posterior extension beyond the rectal wall with expected narrow margins of resection relative to the pre-sacrum (T3 w moderate extension beyond the rectal wall) or lack of free space relative to the pre-sacrum (T4), I would recommend preoperative chemoradiation. If imaging demonstrated the latter, I would also w...

Yes, preoperatively.