When giving total neoadjuvant therapy for rectal cancer, do you sequence radiation and chemotherapy differently depending on the tumor distance from the anal verge?

What do you recommend if the patient would need an APR because of anal sphincter involvement and/or would like to attempt non-operative management?

Answer from: Radiation Oncologist at Academic Institution

With all of the emerging data in rectal cancer and, particularly, if considering non-operative management, I think it is crucial to discuss these patients as part of a multidisciplinary team now more than ever. Prior to starting any therapy, we try to ensure that all of our newly diagnosed rectal ca...

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Radiation Oncologist at Cleveland Clinic Indian River Hospital
Since the chemoradiation or 5 Gy x 5 followed by c...

Answer from: Radiation Oncologist at Academic Institution

That’s a great question, and I’m not sure that it is one that we have the answer to quite yet. When we started treating patients with TNT, we favored starting with chemotherapy first similar to the strategy used in NRG-GI002. With the newer data from studies like OPRA and RAPIDO, we tran...

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Radiation Oncologist at Cleveland Clinic Indian River Hospital
Really helpful. Thank you for the response.

Answer from: Radiation Oncologist at Community Practice

Agree with Dr. @Eric D. Miller's response to the two question combination and the need for patients to be seen by all 3 specialties before initiation of any treatment (RadOnc, MedOnc, colorectal surgeon).However, question 2 does not allow a complete discussion of the issues raised in question 1...

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When giving total neoadjuvant therapy for rectal cancer, do you sequence radiation and chemotherapy differently depending on the tumor distance from the anal verge?

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