Patient Care and Research

ASTRO Appropriate Use Criteria on Customization of Radiation Therapy for Stage II and III Rectal Cancer

Published: May 2016 (Web posted November 2015)

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This practice document used the RAND/University of California, Los Angeles (UCLA) Appropriateness Method, focusing on clinical scenarios for four treatment settings for stage II and III rectal cancer: 1) appropriate neoadjuvant therapy and how it is impacted by risk classification, distance from distal tumor edge to anal verge and distance from radial tumor edge to edge of mesorectal fascia; 2) how circumferential resection margin, risk classification, distance from the anal verge and total nodal count effect choice of adjuvant therapy; 3) treatment for medically inoperable patients and the role of performance status, presence of local symptoms and distance from the anal verge; and 4) chemoradiation with or without boost in patients who sought to avoid or refused abdominoperineal resection. 

Key Points:

  • Neoadjuvant short-course radiation therapy
  • Adjuvant chemoradiation
  • Appropriate treatment for medically inoperable cases
  • Appropriateness of intensity modulated radiation therapy


Gastrointestinal Cancer-Refresher 2017 (CME)
Podcast with document chair
Patient Brochure
RAND/UCLA Appropriate Method User’s Manual

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