How would you treat a T4 rectal cancer invading the uterus that is causing rectal and vaginal bleeding?  

What is your preferred combination and order of therapy for a T4 rectal tumor invading the uterus leading to both rectal and vaginal bleeding? 

Would you recommend upfront neoadjuvant chemoradiation, TNT with initial multi-agent chemotherapy followed by chemoradiation, or an alternative approach? This would be in the setting of the patient and disease allowing for surgical resection.