Table 3 60-year-old woman with circumferential lesion with caudal extent located 8 cm from verge. EUS stage T3N1. KPS. ≥70
From: ACR Appropriateness Criteria® Resectable Rectal Cancer
Treatment | Rating | Comments |
|---|---|---|
RT | ||
Preoperative RT + chemo | 9 | |
Postoperative RT + chemo | 3 | |
Preoperative RT alone | 1 | |
Postoperative RT | 1 | |
If Preoperative RT: RT Dose | ||
45 Gy/1.8 Gy | 7 | |
50.4 Gy/1.8 Gy | 9 | |
54 Gy/1.8 Gy | 7 | If small bowel is completely excluded after 50.4 Gy. |
59.4 Gy/1.8 Gy | 2 | If small bowel is completely excluded after 50.4 Gy. For fixed lesions only. |
5 Gy x 5 | 1 | |
Surgery | ||
LAR | 9 | |
APR | 1 | Only if LAR is not technically possible. |
If Postoperative RT: RT Dose | ||
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. For fixed lesions only. |
5 Gy x 5 | 1 | |
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 | |
RT Technique | ||
3 or 4 field with photons | 9 | Depending on clinical situation. |
IMRT | 6 | May be appropriate depending on the clinical situation on a case-by-case basis. Enrollment in a clinical trial preferred. |