basaloid rectal cancer - better to have surgery or chem-rad first?

Hi there. Presently, there is no definitive evidence to show which one is better in terms of local control and survival: pre operative or post operative chemotherapy with RT. The clinical trials addressing this issue are still under way. However, there are some arguments favoring the use of pre-operative chemoRT and this would include the possibility of "down-staging" the cancer and therefore better ease of removing the lesions during surgery, and theoretically improved chances of local control. For tumors close to the anus, pre-op chemoRT may also increase the salvage rate of the anal sphincter. The argument for doing post-operative chemoRT include the advantage of cleaning up the operative site, if ever the tumor margins are compromised. Recently, more institutions are going for the pre-op sequence of treatment but it really depends on where the institutional preference and experience lies. At the present, both approaches offers the same survival and local recurrence prevention benefit. I suggest you discuss these options at depth with your doctors and I hope that your treatment will go smooth and uneventful. Regards and God bless.

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