For low rectal adenocarcinoma that extends to the anus through the internal sphincter muscle, would you recommend neoadjuvant therapy in a patient who will undergo APR?

Does extension to the anus affect your determination of T classification? Would you consider this a T2 tumor if it does not extend to the external sphincter? Would your recommendation concerning neoadjuvant therapy change if the tumor did extend to the external sphincter?

Answer from: Radiation Oncologist at Academic Institution

Yes, since the margin is positive and local recurrence rates are high for low rectal cancer patients such as this, they should be treated with neoadjuvant chemoradiation including the inguinals with IMRT.

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Radiation Oncologist at Quillen VA Medical Center
I’d love a Canadian or EU to answer weighing...

Radiation Oncologist at University of Florida
Yes.

Answer from: Radiation Oncologist at Academic Institution

Yes, caudal extension to the internal sphincter is typically considered T3. Even in the absence of external sphincter involvement, assessment of the intersphincteric space can be useful for assessing downstaging and for subsequent surgical considerations. And for the reasons Dr. @Christopher H. Cran...

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For low rectal adenocarcinoma that extends to the anus through the internal sphincter muscle, would you recommend neoadjuvant therapy in a patient who will undergo APR?

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