Managing Rectal Adenocarcinoma in a Radiation-Exposed Patient: A Case Report Utilizing the PROSPECT Trial Protocol

This report describes a 76-year-old woman with newly diagnosed rectal adenocarcinoma and a complex oncologic history, including stage IV cervical cancer previously treated with pelvic chemoradiation, which resulted in significant long-term complications. Given her prior extensive radiation exposure, standard neoadjuvant chemoradiation posed substantial toxicity risks. A chemotherapy-first approach, informed by the PROSPECT trial protocol, was therefore implemented. The patient received neoadjuvant FOLFOX chemotherapy followed by surgical resection, achieving tumor regression and favorable pathological outcomes without additional pelvic radiation. This case illustrates the potential role of a PROSPECT-informed, radiation-sparing strategy in carefully selected patients with locally advanced rectal cancer and prior pelvic irradiation, highlighting the importance of individualized, multidisciplinary treatment planning in complex oncologic scenarios.