Colon Cancer and RT

[CUBuffsgrad98]

Looking for some input on a case......... 71 y/o fit man with pT4aN2M0 low grade ACA of descending and sigmoid colon. All margins negative, closest is 3 mm circumferential at abdominal wall. Tumor microscopically penetrates the surface of the visceral peritoneum (T4).

Will get FOLFOX.

Im aware of the evidence (or lack of) for treating/not treating. NCCN says in the fine print "consider RT for T4 with penetration to a fixed structure". Under principles of RT is states RT should be given concurrently with 5FU based chemo.

Would anyone be more inclined to treat or not treat? Concurrent with FOLFOX safe? Opinions appreciated.

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[Gfunk6]

Would not treat, based on data you cited. I only treat these cases when there is organ invasion outside of colon or situations where surgeon could not obtain clear margins (e.g. pelvic sidewall adherence). In those cases I go as high as I can safely with concurrent 5FU. Concurrent FOLFOX is definitely a bad idea.

 

[napoleondynamite]

Would treat if any perforation or abscess formation. Otherwise, I let my surgeon guide me in these cases where margins are close next to the sidewall. It's an area we can clearly target, so if the surgeon is worried, I zap. No, never with FOLFOX, but I would use 5FU or Xeloda concurrent.

 

[clinonc]

RT has been used with oxaliplatin in the neo-adjuvant setting (http://www.ncbi.nlm.nih.gov/pubmed?term=23109696).

I wouldn't treat the above patient. It would make management of the anastomotic recurrence more difficult for the surgeon if nothing else.

Out of interest: for the theoretical patient with the positive pelvic side wall margin, would you treat the whole pelvis, or just the side wall? I would treat the pelvis to 45 Gy, with a boost to the PSW of 50-54 Gy, with 5FU-based chemo.

 

[Palex80]

I wouldn't do it.

 

[CUBuffsgrad98]

Thanks for the responses. For clinonc, I would treat the area of gross disease and greatest risk of recurrence (pelvic sidewall), but not the whole pelvis.

 

[medgator]

Would not treat, based on data you cited. I only treat these cases when there is organ invasion outside of colon or situations where surgeon could not obtain clear margins (e.g. pelvic sidewall adherence). In those cases I go as high as I can safely with concurrent 5FU. Concurrent FOLFOX is definitely a bad idea.

I didn't realize it but apparently there is data for concurrent rt with folfox in esophageal ca with recognition in the nccn

 

[CUBuffsgrad98]

Medgator, I saw this when researching if there were any colon CA cases with RT and FOLFOX. Phase III trial RT+ Folfox vs RT +cis/5FU. Less toxic with FOLFOX, I believe. Mostly abandon in the the conclusion due to the publication of CROSS trial prior to this one being published. I was pretty surprised I had never heard of this