Postby Rock_Robster » Thu Apr 21, 2022 8:43 pm
Hi Claudine, really interesting and tough question.
As you know radiation for rectal cancer is usually done neoadjuvantly, so much of the tissue that was radiated ends up being removed (and the primary target is the tumour, with wider field coverage on marginal tissue and lymph nodes). In this case given it’s post-op, have they discussed what they would actually be targeting with radiation? I assume they wouldn’t be aiming much dose toward the neorectum itself given it’s so far from where the primary tumour was - perhaps it’s more for the lymphatics which might not impact bowel function long-term as much. Also, what was the lymph node pathology after the ULAR?
Although, to be blunt, with an inch of rectum left I’d say it’s almost inevitable he will experience some degree of LARS after surgery regardless. I’ve had radiation, an ileostomy, reversal and LARS, but thankfully 2+ years later my function is now really good. But my primary was 10cm high so I think I had about 2 inches of rectum left post-op (which stretches/expands over time). It’s true that a permanent ostomy is always an option after reversal, although many colorectal surgeons aren’t prepared to go down that path until at least a year of recovery has been observed - so may be worth testing that with them too.
Everyone is different so of course take this with a massive grain of salt, but if it were me in his case and knowing what I know now, I’d probably go for the radiation and a permanent ostomy now. Severe LARS is an extraordinary drain on quality of life, whereas lifestyle with a colostomy can be very good, and the radiation should be very tolerable if he isn’t worried about bowel movements. But to each their own - some people can’t stand the bag, and I totally get that.
Cheers,
Rob
41M Australia
2018 Dx RC
G2 EMVI LVI, 4 liver mets
pT3N1aM1a Stage IVa MSS NRAS G13R
CEA 14>2>32>16>19>30>140>70
11/18 FOLFOX
3/19 Liver resection
5/19 Pelvic IMRT
7/19 ULAR
8/19 Liver met
8/19 FOLFOX, FOLFOXIRI, FOLFIRI
12/19 Liver resection
NED 2 years
11/21 Liver met, PALN, lung nodules
3/22 PVE, lymphadenectomy, liver SBRT
10/22 PALN SBRT
11/22 Liver mets, peri nodule. Xeloda+Bev
4/23 XELIRI+Bev
9/23 ATRIUM trial
12/23 Modified FOLFIRI+Bev
3/24 VAXINIA (CF33 + hNIS) trial