How would you treat very locally aggressive rectal cancer extending into muscle and causing internal iliac tumor thrombus, in a patient who is not a surgical candidate?

What volumes and doses of radiation would you recommend? To what dose would you limit the rectum, especially in a patient with no salvage surgical options if toxicity occurs?

Answer from: Radiation Oncologist at Academic Institution

I would treat with chemoradiation, 50.4 Gy/28 fx using a 3D conformal technique and standard rectal cancer volumes. The lumbosacral plexus prevents doses higher than 60 Gy, and in general there not much evidence of dose response between 50Gy and 60Gy.

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How would you treat very locally aggressive rectal cancer extending into muscle and causing internal iliac tumor thrombus, in a patient who is not a surgical candidate?

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