Table 2 70-year-old woman staged with EUS, aT2NX rectal cancer with caudal extent located 9 cm from verge, final pathology was T3N1 status post low anterior resection (LAR), KPS ≥70
From: ACR Appropriateness Criteria® Resectable Rectal Cancer
Treatment | Rating | Comments |
|---|---|---|
Treatment Options | ||
RT + chemotherapy | 9 | |
RT alone | 2 | |
Chemotherapy alone | 2 | |
If RT + Chemo: RT Dose to Primary | ||
45 Gy/1.8 Gy | 6 | |
50.4 Gy/1.8 Gy | 9 | |
54 Gy/1.8 Gy | 8 | If small bowel is completely excluded after 50.4 Gy. |
59.4 Gy/1.8 Gy | 3 | If small bowel is completely excluded after 50.4 Gy. |
Simulation | ||
Patient prone | 9 | Unless physically unable. If using IMRT technique, may prefer supine. |
Small-bowel contrast at simulation | 9 | Not mandated with CT simulation. |
Patient immobilized | 9 | |
Use belly board | 9 | Only needed if prone. |
Anal marker | 9 | |
Bladder full at simulation | 7 | |
If RT + Chemo: RT Volume | ||
L5/S1 pelvis to include anal marker | 2 | CT simulation preferred. Use CT to ensure margin on inferior extent of tumor. Technically, the field should extend 2-3 cm below the anastomosis on the CT. |
L5/S1 pelvis to bottom of ischial tuberosity | 5 | CT simulation preferred. Bony landmark is an approximation. Use CT to ensure margin on inferior extent of tumor. Technically, the field should extend 2-3 cm below the anastomosis on the CT. |
RT Technique | ||
3 or 4 field with photons | 9 | Depending on clinical situation. |
AP/PA | 1 | |
IMRT | 6 | May be appropriate depending on the clinical situation on a case-by-case basis. Enrollment in a clinical trial preferred. |