Would you offer adjuvant chemotherapy or radiation to a resected MSS T3N0 high-rectal lesion with low anterior resection without pre-op therapy?
Staging/pre-op MRI only showed mild non-specific thickening.
Answer from: Radiation Oncologist at Community Practice
For patients with T3N0 upper rectal cancer with no significant risk factors (R0, CRM clear, no EMVI) who undergo high quality TME surgery as suggested by an intact TME pathologic specimen, the 5-year risk of pelvic recurrence without the delivery of adjuvant radiotherapy is < 5%. I do not recomme...
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Answer from: Medical Oncologist at Academic Institution
This is a situation we have from time to time since our staging modalities are still way from perfect. Some patients with MRI or rectal EUS considered to have T1/2N0 disease underwent surgical resection and were found to have T3N0 disease in the final pathology specimen. The current NCCN guidel...
Comments
Medical Oncologist at Jackson-Madison County General Hospital
Thank you for your thoughtful reply. Very helpful!
Thank you for your thoughtful reply. Very helpful!
Medical Oncologist at Cancer Center Overlook Hospital
Since this is a high rectal lesion, would also hav...
Since this is a high rectal lesion, would also hav...
Answer from: Medical Oncologist at Academic Institution
This is a situation where I would consider extrapolating from the DYNAMIC trial (Tie et al., PMID 35657320) using post-op ctDNA testing to risk stratify for the benefit of adjuvant chemotherapy. I agree with others that adjuvant radiation is not indicated in this situation (assuming clear margi...
Answer from: Medical Oncologist at Community Practice
Would use cDNA to determine the need for any adjuvant therapy.