Questions discussed in this category
Do you find that starting with chemoradiation increases the risk of complete obstruction secondary to transient tumor inflammation, or do you favor st...
Is there data on neoadjuvant chemo-RT or chemo in this setting?
How do you construct the caudal extent of your volume - for example, pelvic floor via RTOG/international consensus vs 4 cm below gross disease via RAP...
Does it ever differ from a standard rectal field? For example, do you always treat the entire rectum, mesorectum, and entire length of internal iliac ...
Would you cover the entire prostate?
For example, if mass is ulcerated and cannot be excised with polypectomy? Would you ever consider radiation and chemotherapy?
Current NCCN guidelines do not include adjuvant chemotherapy for patients treated in this fashion; however, in the PROSPECT trial itself, an additiona...
Intravesical therapy was delivered two years prior, and last cystoscopy was negative. One-third of the bladder would otherwise be included in the plan...
What factors might play into this decision?
Consider some stalk invasion, but no deep submucosal extent and negative margins by 9 mm.
Especially as the study was done before the adoption of total neoadjuvant therapy
Consider a patient who prioritizes fertility preservation, for whom one of three suspicious nodes approaches the CRM, and is <1 mm from the mesorec...
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...
With trials like PROSPECT and FOWARC showing no statistically significant improvement in locoregional control and survival outcomes when comparing rad...
Especially consider a situation where surgical excision alone is not appropriate.
What if the radiation was LDR or HDR brachytherapy?
How are you approaching patients with rectal cancer who meet PROSPECT criteria but have other higher risk features, such as >4 lymph nodes with sus...
In general: when would you recommend adjuvant radiation and capecitabine for a colon cancer?
Do you have a preference in ordering MRI, endoscopy, CT scan (chest, abdomen, pelvis), EUS, or other testing before starting any treatment, for re-sta...
Since there is no overlap between chemo regimens for these cancers, how would you sequence treatment?
What systemic therapy is most appropriate, how would you sequence, and what RT dose fractionation would you use?
Would the location of the tumor (i.e. ultralow), symptoms (bleeding), or patient resistance to surgery play into this decision?
Would this change if the cancer was p16+ squamous cell carcinoma?
The patient has sustained a positive response for >1 year after diagnosis.
How would you sequence therapy, and what dose and volumes would you use for radiation? Prostate cancer is localized, Gleason 4+3, PSA 65.
Is concurrent chemoradiation reasonable or excessive in a patient with life expectancy <5 yrs? Should the standard be 5 Gy x 5, and will this provi...
Taking into account follow up from NEO, OPERA and other organ preservation trials?
Are you more inclined to offer brachytherapy boost instead of EBRT boost?
Would you boost involved lateral pelvic lymph nodes in this scenario?
Given the published results of the PRODIGE 23 trial where FOLFORINOX was used neoadjuvantly with FOLFOX post-op
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...
How do you weigh definitive chemoRT vs minimally invasive surgical approach with neoadjuvant chemo followed by transanal excision, in light of results...
Are you more likely to consider a trans-anal resection?
If records have been destroyed, how do you factor prior pelvic radiation for prostate cancer into your decision?
How does your counseling about side-effects change when offering short vs long course radiation?
If the patient is amenable to adjuvant chemotherapy alone, but is worried about chronic diarrhea/urgency after radiation, how would you counsel them?
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...
The patient has disease in the S2/S3 region with an anterior soft tissue mass.
The patient previously received 50.4 Gy with treatment for rectal canc...
Any adjustments in terms of elective nodal coverage?
Are there clinical scenarios in which you have found chemotherapy first has been beneficial?
(i.e., advanced T stage, extra-mesorectal LN, anat...
Total neoadjuvant therapy (TNT) included FOLFOX x 4 months and concurrent chemo-RT
Do you worry about fluoropyrimidine resistance with concurrent chemoRT? Is there any role for neoadjuvant immunotherapy?
Would your decision be influenced by whether a pathologic complete response was attained?
Colleagues in surgery have raised concerns about post radiation effects in the pelvis with the ordering of short course RT->chemo ->surgery.
When using short course RT, the NCCN guidelines currently recommend short course RT followed by chemotherapy, followed by surgery. Many surgeons are h...
Would you consider treating 3-5mm lesions with SBRT or wait until they are a certain size? I am concerned I will not be able to see them adequately on...
Are these patients better candidates for preop chemotherapy alone?
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...
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...
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Papers discussed in this category
International journal of radiation oncology, biology, physics, 2012-04-01
Lancet Oncol., 2015 Dec 16
Lancet,
Gastrointestinal cancer research : GCR, 2007-03
Journal of the National Comprehensive Cancer Network : JNCCN, 2014-04
Cancer medicine, 2016-12
Int. J. Radiat. Oncol. Biol. Phys., 1988-05-01
Int J Radiat Oncol Biol Phys, 2016 Jul 15
Journal of geriatric oncology, 2018-03
International journal of radiation oncology, biology, physics, 2001-01-01
Lancet Gastroenterol Hepatol, 2017-07-01
Dis. Colon Rectum, 2017-10-01
Ann. Oncol., 2016-05-01
International journal of radiation oncology, biology, physics, 2017-10-01
Clinics in colon and rectal surgery, 2012-06
Eur J Gastroenterol Hepatol,
The Lancet. Oncology, 2015-08
Radiother Oncol, 2020 Mar 30
Ann. Surg., 2020 Mar 20
Lancet Oncol., 2017-03-01
Adv Radiat Oncol, 2020 Apr 22
Lancet Oncol, 2020 Dec 07
Ann Oncol,
Lancet Oncol, 2021 Apr 13
N Engl J Med, 2018 Mar 29
J. Clin. Oncol., 2019 Oct 08
Lancet Oncol., 2016-06-01
The Lancet. Oncology, 2019-04
J Natl Cancer Inst,
Lancet Oncol, 2021 May 04
Int J Radiat Oncol Biol Phys, 2019 Dec 1
Pract Radiat Oncol, 2020 Oct 21
International journal of radiation oncology, biology, physics, 1988-02
Lancet Oncol,
World J Gastroenterol,
JAMA oncology, 2018-06-14
British journal of cancer, 2017-06-06
Ann Surg,
Lancet Oncol., 2011 May 17
International journal of radiation oncology, biology, physics, 1999-02-01
J Clin Oncol,
N Engl J Med, 2022 Jun 05
Diseases of the colon and rectum, 2014-01
Adv Radiat Oncol, 2020 Aug 07
Int J Radiat Oncol Biol Phys, 2001 Jul 15
Advances in radiation oncology, 2016
Radiother Oncol, 2014 Nov 26
J Clin Oncol, 2022 Apr 28
N Engl J Med, 2022 Nov 03
Journal of clinical oncology : official journal of the American Society of Clinical Oncology, 2004-05-15
Lancet Gastroenterol Hepatol, 2023 Feb 16
Clinical cancer research : an official journal of the American Association for Cancer Research, 2018-05-01
Asia-Pacific journal of clinical oncology, 2020 Aug 05
Annals of surgical oncology, 2020 May 13
Diseases of the colon and rectum, 2019 Jun
J Clin Oncol, 2022 Aug 18
JAMA Surg, 2019 Jan 01
The Lancet. Oncology, 2015-11
Int J Radiat Oncol Biol Phys, 2012 Jul 03
Oncology, 2022 Oct 28
Journal of clinical oncology : official journal of the American Society of Clinical Oncology, 2012-11-01
Ann Surg, 2023 Jan 20
Radiother Oncol, 2004 Jul
JAMA Surg, 2019 Sep 18
J Clin Oncol, 2019 Sep 26
Ann Oncol, 2022 Oct 25
J Clin Oncol, 2023 Jun 04
N Engl J Med, 2023 Jun 04
N. Engl. J. Med., 2004-10-21
Ann Surg, 2020 Mar
Lancet Oncol, 2023 Jun 02
N. Engl. J. Med.,
Radiotherapy and oncology : journal of the European Society for Therapeutic Radiology and Oncology, 2017-01
Am J Clin Oncol,
Frontiers in oncology, 2023 Jun 29
European journal of surgical oncology : the journal of the European Society of Surgical Oncology and the British Association of Surgical Oncology, 2021 Dec 20
Colorectal disease : the official journal of the Association of Coloproctology of Great Britain and Ireland, 2010 Oct
Cancer medicine, 2018-12
Oncology (Williston Park, N.Y.), 2018-01-15
Frontiers in oncology, 2023 Jun 08
Cancers, 2022 Jul 28
International journal of radiation oncology, biology, physics, 2019 Aug 30
The American surgeon, 2015 May
Lancet (London, England), 2009-03-07
Ann Surg, 2011 Apr
JAMA Oncol, 2019 Jul 01
J Clin Oncol, 2023 Jun 19
JAMA oncology, 2023 Dec 21
International journal of radiation oncology, biology, physics, 2024 Jan 05
Journal of clinical oncology : official journal of the American Society of Clinical Oncology, 2022 Mar 09
Seminars in oncology, 2006-12
Journal of clinical oncology : official journal of the American Society of Clinical Oncology, 2008-01-20
Journal of clinical oncology : official journal of the American Society of Clinical Oncology, 2002-04-01
Journal of clinical oncology : official journal of the American Society of Clinical Oncology, 2022 Oct 28
JAMA oncology, 2019 Nov 01
International journal of radiation oncology, biology, physics, 2010 Jun 18
Journal of gastrointestinal surgery : official journal of the Society for Surgery of the Alimentary Tract, 2017-10
The New England journal of medicine, 2003-07-17
Journal of clinical oncology : official journal of the American Society of Clinical Oncology, 2011-08-10
Journal of clinical oncology : official journal of the American Society of Clinical Oncology, 2011-04-01
Nat Med, 2023 Jan 16