Dr. VanderWalde on Utility of Radiation Therapy in Rectal Cancer

Noam VanderWalde, MD, MS, an associate professor of radiation oncology at West Cancer Center and Research Institute, discusses radiation therapy in early-stage versus later-stage rectal cancer.

In patients with earlier-stage disease, for example, those with node-negative disease, the use of preoperative radiation therapy is dependent on the tumor location, says VanderWalde. In a patient who has high-grade rectal cancer, such as T2 or T3, it may be preferred to avoid radiation, added VanderWalde. Data from several studies have demonstrated that patients with high T3 disease have a very low risk of locoregional recurrence. 

That being said, a low-lying rectal cancer may require abdominoperineal resection (APR) if the patient did not receive any downstaging, says VanderWalde. In those patients, radiation may be used even though they have a lower-stage cancer. The goal of this is to provide patients with nonoperative management of their disease or to go from an APR to a low anterior resection, concludes VanderWalde.