ARRO now has Fellowship panel

[madchemist89]

I wouldn't count out xrt in rectal yet. Upfront total neoadjuvant treatment may allow for an organ sparing approach one day. Some centers are already doing this. I would say having intact rectum probably is better QOL than without even with everything reconnected. Also, one of the GRECCAR trials showed that downstaging with neoadjuvant treatment may allow for less extensive surgery and rectal preservation.

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[medgator]

I wouldn't count out xrt in rectal yet. Upfront total neoadjuvant treatment may allow for an organ sparing approach one day. Some centers are already doing this. I would say having intact rectum probably is better QOL than without even with everything reconnected. Also, one of the GRECCAR trials showed that downstaging with neoadjuvant treatment may allow for less extensive surgery and rectal preservation.

I think for those cases where an Apr would be required, agree. I think observation/surveillance is in the NCCN now iirc in those situations, similar to anal scc.

Still doesn't justify Ass Man fellowship, even though Montreal is a great city

 

[RickyScott]

I wouldn't count out xrt in rectal yet. Upfront total neoadjuvant treatment may allow for an organ sparing approach one day. Some centers are already doing this. I would say having intact rectum probably is better QOL than without even with everything reconnected. Also, one of the GRECCAR trials showed that downstaging with neoadjuvant treatment may allow for less extensive surgery and rectal preservation.

I agree that for organ preservation, xrt will still be needed but that is only a small component of rectal cases. For the remaining cases, the absolute local benefit of xrt is less than modest. Short of avoiding an apr, surgeons will never be on board with a non operative approach to rectal.

 

[TheWallnerus]

I wouldn't count out xrt in rectal yet. Upfront total neoadjuvant treatment may allow for an organ sparing approach one day. Some centers are already doing this. I would say having intact rectum probably is better QOL than without even with everything reconnected. Also, one of the GRECCAR trials showed that downstaging with neoadjuvant treatment may allow for less extensive surgery and rectal preservation.

I will not count XRT out, but it has a fight on its hands.

And if it doesn't get punched out, 'twill be a Pyrrhic-y victory for us and we will all be doing 5 fraction rectal.

 

[evilbooyaa]

I agree that for organ preservation, xrt will still be needed but that is only a small component of rectal cases. For the remaining cases, the absolute local benefit of xrt is less than modest. Short of avoiding an apr, surgeons will never be on board with a non operative approach to rectal.

I have seen more and more patients refuse even a LAR in the setting of a CCR to TNT. I don't foresee omission of chemoRT.

I will not count XRT out, but it has a fight on its hands.

And if it doesn't get punched out, 'twill be a Pyrrhic-y victory for us and we will all be doing 5 fraction rectal.

While Wash U has some interesting data in the SC-NOM setting, it'll probably still be a few years until it's SOC for those pursuing NOM.

 

[RadOncDoc21]

In general as a field, we will always find a way to kill ourselves.

 

[Gfunk6]

 

[DrZap]

I agree that for organ preservation, xrt will still be needed but that is only a small component of rectal cases. For the remaining cases, the absolute local benefit of xrt is less than modest. Short of avoiding an apr, surgeons will never be on board with a non operative approach to rectal.

Depends on the surgeon (and likely their practice setting). Can think of a hospital employed surgeon who often offers a non op approach

 

[deleted1111261]

I agree that for organ preservation, xrt will still be needed but that is only a small component of rectal cases. For the remaining cases, the absolute local benefit of xrt is less than modest. Short of avoiding an apr, surgeons will never be on board with a non operative approach to rectal.

Very regional. Our surgeon here loves non operative- more so than I would expect, as I generally favor trimodality.

 

[medgator]

Very regional. Our surgeon here loves non operative- more so than I would expect, as I generally favor trimodality.

Functional sphincter > bag > useless sphincter