Volumetric modulated arc technique radiotherapy in synchronous locally advanced rectal and very high-risk prostate cancer

Synchronous rectal and prostate cancer is difficult to manage due to old age, complexity of pelvic anatomy, and high morbidity associated with surgery. There is very limited literature available on detailed nonsurgical management. Even achieving high-dose radiotherapy (>70 Gy) for prostate is challenging due to the proximity of rectum, which itself is a target. Few literatures focus on neoadjuvant radiation, but it causes high morbidity following surgery. Other literatures focus on conventional 2 phase radiation, which either is neoadjuvant followed by surgery or causes high toxicity. With the advancement in radiotherapy techniques, volumetric modulated arc technique (VMAT) promises treatment without prostatectomy, with sphincter preservation, and minimal morbidity. Here, we are presenting a case on synchronous locally advanced rectal and very high-risk prostate cancer, treated with radical VMAT technique. Due to the radical dose given in 4 phases, the patient need not undergo surgery, achieved complete response with no symptoms following 6 months of treatment.