Would you use standard neoadjuvant chemoradiation for a patient with advanced rectal cancer and a history of previous pelvic RT for another cancer?
For a patient with cT3-4N0 rectal cancer, does the dose of the previous RT affect your decision making (for example, 45 Gy to the pelvis with boost to 50.4 Gy for adjuvant treatment of endometrial cancer)? Do you look for a minimum time between the prior RT and re-irradiation?
Answer from: Radiation Oncologist at Academic Institution
No. We have to remember that the benefit of radiation in locally advanced rectal cancer is limited to a local control benefit; and must balance the risks/benefits as such. Moreover, there are T3 tumors with an uninvolved mesorectal fascia(1) where the role of radiation may be more limited; since a ...
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Answer from: Radiation Oncologist at Academic Institution
In addition to increased R-resection, the benefit of chemoradiation is also in the treatment of non-TME nodes. The MERCURY trial and Deb Schrag's paper are in highly favorable patients (small, High T2, T3 / N0). I would not treat most of those patient with or without prior radiation. However, in the...