How would you approach a low-lying rectal cancer wtih para-aortic lymphadenopathy?   

I will assume that the question is one of management for oligometastatic nodal M1 disease--i.e. one or two para aortic lymph nodes and no other extrapelvic disease. In the past I've treated a few cases like this, as well as a few that were M1 by virtue of inguinal or iliac nodal metastases. The co...

I agree with Bob's comments about the integration of radiation with chemotherapy. I wanted to emphasize the point that that the peraaortic nodal chain is a regional nodal volume and disease can sometimes be isolated there. If you think that the disease could be isolated to the periaortics, ...

I would definiitely use IMRT.  I think one can do a much better job limiting dose to bowel and kidneys with IMRT vs. 3D.  While the choice of IMRT over 3D might increase the volue receiving low doses, when the prescription dose is 25Gy/5fx to the high dose regions and 20Gy/5fx to elective ...