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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 hesitant to allow a 4 month interval between radiation and surgery (given a worry for disruption and scarring of tissue planes). Is this a valid concern? Or, is a 4 month interval too short an interval to see significant disruption of surgical planes?
Answer from: Radiation Oncologist at Academic Institution
Short answer: No, there is no data suggesting that this regimen and its longer wait is detrimental to operative morbidity for rectal cancer. Long answer: The concern about the delay from TNT, whether short course radiation->chemotherapy OR chemoradiation->chemotherapy prior to surgery has...
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Answer from: Radiation Oncologist at Community Practice
This is a really timely question. Given the COVID-19 pandemic, my colleagues and I just mandated short course radiation for all rectal cancer patients treated with pre-operative radiation at our center (Romesser et al., Advances in Radiation Oncology 2020). The Stockholm III trial, which evaluated S...
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Radiation Oncologist at Washington University School of Medicine
One should note that the preoperative chemotherapy...
One should note that the preoperative chemotherapy...
Answer from: Radiation Oncologist at Academic Institution
Great question. Our surgeons have not noticed an increase in difficulty or complications with this delay. However, the definitive answer should come from the 3-year results of the RAPIDO trial, which is due to be presented next month at the (virtual) 2020 ASCO meeting.
Answer from: Radiation Oncologist at Community Practice
Good question. There is always the issue of scarring and difficulty with surgery with increasing time from the end of radiation therapy.A second question would be: how long will the effect of a sub-therapeutic dose of radiation therapy last before you have an increase in tumor growth? One study show...
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Radiation Oncologist at Washington University School of Medicine
Actually Michel et al found that, in their study, ...
Actually Michel et al found that, in their study, ...