In which clinical scenarios would you prefer to sequence chemotherapy prior to radiation therapy in total neoadjuvant therapy for locally advanced rectal cancer?

Are there clinical scenarios in which you have found chemotherapy first has been beneficial?

(i.e., advanced T stage, extra-mesorectal LN, anatomical constraints, near obstruction, etc)

Answer from: Medical Oncologist at Community Practice

Our institutional preference has been to use long course chemoradiotherapy prior to chemotherapy due to the enhanced clinical response rate. The exceptions have been for patients with obstructive physiology, where chemotherapy first can potentially generate a safer and more rapid response. Chemother...

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Radiation Oncologist at Fox Chase Cancer Center
I agree with Dr. @Michael Shusterman. We generally...

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In which clinical scenarios would you prefer to sequence chemotherapy prior to radiation therapy in total neoadjuvant therapy for locally advanced rectal cancer?

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