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Radiation Oncology • Genitourinary Cancers
How do you treat synchronous rectal cancer and prostate cancer?
I have a healthy 70+ year old man recently diagnosed with cT3N1M0 rectal adenoCA and GS 3+4=7 prostate cancer in 1/6 cores with a PSA of 25.
Is there a role for treating both cancers with a "total neoadjuvant therapy" approach for the rectal cancer?
Would you use a hypofractionated approach to the prostate such as 70 Gy in 28 fractions while treating the rectum to 50.4 Gy?
Answer from: Radiation Oncologist at Community Practice
There are several case reports describing the treatment of localized synchronous prostate and rectal cancer. Combined radical retropubic prostatectomy and rectal resection has been described but is associated with high morbidity (Klee et al.). Definitive external beam chemoradiation therapy with 5-F...
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Answer from: Radiation Oncologist at Academic Institution
One approach that I have used for similar cases (for a very small n=2) involved treating the rectal cancer with preop RT (50.4 Gy to standard rectal fields) with capecitabine, but modifying the coverage around the prostate to include prostate+8 mm. External iliac LNs were not included. Dose to the p...
Answer from: Radiation Oncologist at Community Practice
Are there any updates to this question? Also, would the recommendation differ if the prostate cancer was low/very low risk and the patient was otherwise a good candidate for active surveillance?
Comments
Radiation Oncologist at Vanderbilt-Ingram Cancer Center
Not too much compared to a decade ago, besides tha...
Not too much compared to a decade ago, besides tha...