Rectal Cancer&nbsp;&nbsp;&nbsp;

For patients with large, partially or nearly obstructing rectal cancers, how do you sequence TNT in order to avoid complete obstruction and surgical diversion?

Do you find that starting with chemoradiation increases the risk of complete obstruction secondary to transient tumor inflammation, or do you favor st...

What is your approach to TNT sequencing for locally advanced rectal primaries with low volume metastatic disease to liver?

Would you consider circulating DNA assay in resected node-negative deficient MMR colon cancer off-trial to guide your treatment?

6 Answers available

How would you treat an MMR-proficient T2 N0 low-rectal cancer (measuring 2 cm extending 4-6 cm from the anal verge) in a patient who wishes to preserve his sphincter?

Is there data on neoadjuvant chemo-RT or chemo in this setting?

In what situations would you treat a rectal mass as cancer despite negative biopsies?

For example, if mass is ulcerated and cannot be excised with polypectomy? Would you ever consider radiation and chemotherapy?

In which patients with early stage rectal cancer treated according to the PROSPECT paradigm do you recommend adjuvant chemotherapy?

Current NCCN guidelines do not include adjuvant chemotherapy for patients treated in this fashion; however, in the PROSPECT trial itself, an additiona...

What is your approach to cT3N0M0 mid rectal adenocarcinoma with clear circumferential resection margins on MRI?

For patients with locally advanced rectal cancer who desire organ preservation and can tolerate fluoropyrimidine but not oxaliplatin, what is the appropriate treatment approach?

Would you recommend additional post-operative chemoradiation for a T2N1 proximal rectal cancer having received adjuvant capecitabine/oxaliplatin?

What factors might play into this decision?

For a pedunculated rectal polyp found to be adenocarcinoma after endoscopic removal, with PNI as the only adverse feature, would you recommend additional treatment such as surgery or chemoradiation?

Consider some stalk invasion, but no deep submucosal extent and negative margins by 9 mm.

How will the PROSPECT trial presented at ASCO 2023 change your current management of early rectal cancer?

Especially as the study was done before the adoption of total neoadjuvant therapy

For patients with rectal cancer being treated along PROSPECT paradigm, would you extrapolate from the IDEA literature and offer 3 months of CAPOX neoadjuvantly, without adjuvant therapy?

Would you offer neoadjuvant radiation therapy with concurrent chemotherapy for a T4 rectal carcinoma with an associated rectovesical fistula?

How would you treat an elderly patient (ECOG 0-1) with locally advanced rectal cancer and synchronous Merkel cell cancer of the extremity requiring adjuvant RT?

Would you treat both at the same time? Does one need to be prioritized over the other? Does Xeloda have any efficacy against Merkel cell cancer? How...

What are your top takeaways in GI Cancers from ASCO 2023?

6 Answers available

Would you recommend adjuvant capecitabine and radiation in addition to adjuvant FOLFOX for a patient with resected pT3N2 rectosigmoid adenocarcinoma with other high-risk pathologic features?

In general: when would you recommend adjuvant radiation and capecitabine for a colon cancer?

How would you sequence treatment of a synchronous IC1 high-grade serous ovarian cancer and cT3N1 rectal cancer?

Since there is no overlap between chemo regimens for these cancers, how would you sequence treatment?

0 Answers available

How would you treat a synchronous low rectal adenocarcinoma and anal squamous cell carcinoma with involved pelvic and inguinal nodes?

What systemic therapy is most appropriate, how would you sequence, and what RT dose fractionation would you use?

6 Answers available

Would you offer adjuvant chemotherapy after SBRT for biopsy proven sub centimeter metastatic pulmonary nodule from rectal cancer?

What is the recommended follow-up/surveillance schedule following organ preservation treatment approach for cT1-2N0 rectal cancer?

Taking into account follow up from NEO, OPERA and other organ preservation trials?

How would you approach a T3N1M0 mid rectal cancer that is MMR deficient?

Do you try to incorporate mFOLFIRINOX in total neoadjuvant therapy for rectal cancer?

Given the published results of the PRODIGE 23 trial where FOLFORINOX was used neoadjuvantly with FOLFOX post-op

Is there a correlation between rectal cancer stage and dose response to radiotherapy?

Dose-escalation RT trials have had mixed results in the past for advanced rectal cancer, while in the early rectal stage there is a tendency towards a...

For patients with cT1-T3 cN0 cM0 mid/low rectal cancer seeking organ preservation, what treatment approach do you recommend?

How do you weigh definitive chemoRT vs minimally invasive surgical approach with neoadjuvant chemo followed by transanal excision, in light of results...

Would you be willing to give definitive chemo-radiation and chemotherapy to a MSI-stable T2N0 low lying rectal cancer in a young healthy patient who wants to avoid surgery?

Are you more likely to consider a trans-anal resection?

For a rectal cancer with questionable T3 or questionable N+ by MRI, can short course radiation be given followed by surgery and the pathology still be interpreted to guide adjuvant chemotherapy?

I.E., can a patient with a questionable 5 mm node (MRI T2N1) which is negative on pathology after short course radiation be staged T2N0 and receive no...

Would you consider upfront immunotherapy in a patient with MSI strongly positive locally advanced adenocarcinoma of the anus versus standard of care?

Would you treat rectal squamous cell carcinoma the same as rectal adenocarcinoma, stage for stage?

Any adjustments in terms of elective nodal coverage?

Would you recommend adjuvant chemotherapy for a patient who achieved a CR after TNT for stage III rectal adenocarcinoma but underwent no initial surgery, and now has a local recurrence >12 months later with plans to undergo low-anterior resection?

Total neoadjuvant therapy (TNT) included FOLFOX x 4 months and concurrent chemo-RT

What is your approach to neoadjuvant chemotherapy for a T3N0 mid-rectal cancer?

How would you approach the treatment of early stage rectal adenocarcinoma in patients with confirmed Lynch Syndrome?

Do you worry about fluoropyrimidine resistance with concurrent chemoRT? Is there any role for neoadjuvant immunotherapy?

Would you offer additional adjuvant FOLFOX for patients with rectal CA undergoing TNT who transition to cape/RT and subsequent surgery early due to absence of clinical response to FOLFOX?

Would your decision be influenced by whether a pathologic complete response was attained?

For locally advanced rectal cancer, would you consider utilizing the RAPIDO trial approach of short course radiation followed by neoadjuvant chemotherapy prior to surgery?

Colleagues in surgery have raised concerns about post radiation effects in the pelvis with the ordering of short course RT->chemo ->surgery.

5 Answers available

How would you manage early-stage low rectal cancer in a patient unable or unwilling to undergo surgery?

Would you consider adding HER2 targeted treatment to chemotherapy for a patient with locally advanced, HER2+ rectal cancer who is going to have total neoadjuvant treatment?

What is the preferred number of cycles of CAPOX for rectal cancer receiving total neoadjuvant chemotherapy?

How do you sequence short course radiation for locally advanced rectal cancer when using the total neoadjuvant approach?

When using short course RT, the NCCN guidelines currently recommend short course RT followed by chemotherapy, followed by surgery. Many surgeons are h...

When do you consider total neoadjuvant therapy (chemotherapy and chemoradiation) for rectal cancer?

When would you consider initial induction chemotherapy (e.g. FOLFOX) followed by neoadjuvant chemoradiation, over neoadjuvant chemoradiation alone, in patients with locally advanced rectal cancer?

Which patients would you offer a watch-and-wait approach versus surgical resection after chemoradiotherapy for patients with rectal cancer?

5 Answers available

For rectal cancer with solitary liver metastasis, do you recommend neoadjuvant chemoradiation?

Are these patients better candidates for preop chemotherapy alone?

How do you approach disease monitoring in patients with localized rectal cancer who have received treatment with chemoradiation?

Is MRI being considered the primary mode of imaging in multidisciplinary tumor boards, especially in light of the results of the MERCURY trial (JCO 20...

Should capecitabine be administered at a specific time prior to RT in pre-op chemoradiation treatment for rectal cancer?

Would taking the drug at a specific time point prior to their radiation appointment time to maximize blood levels of the drug be clinically beneficial...