When treating rectal cancer with neoadjuvant chemoRT, is it appropriate to employ IMRT planning, rather than 3D conformal, for all cases, or should IMRT be reserved for special circumstances?  

Special circumstances. When considering the use of IMRT for any disease site, one should always have evidence to support it over 3D CRT or at least a good rationale if there is a gap in the evidence. For rectal cancer, there is not much evidence that IMRT reduces acute GI toxicity. The RTOG 0247 w...

Have not done 3D in 12-13 years. I am not sure why every other pelvic malignancy would be treated with 3D, but rectal would not. We treat prostate, cervical, endometrial, vulvar, vaginal, anal - all with IMRT. At my residency at UPMC from 2006-2010, almost all cases I saw were treated with IMRT and ...

3D CRT for most patients, agree with Dr. Crane for IMRT for special situations. I would advocate for daily CBCT for all patients so that we can achieve more consistent bladder and rectum filling and patient positioning with the goal of reducing CTV/PTV margins and dose to OARs and side effects. ...