Fig. 5.

The magnetic resonance (MR) image before CRT and CXB demonstrated an anterior low rectal tumor, which demonstrated 9 mm of mesorectal extension, stage T3C N0 (arrows, A, B). Sigmoidoscopy at this point revealed a 3 cm tumor at 5 cm from the anus (C). At 12 months after chemoradiotherapy with a Papillon boost, there is maturing fibrosis at the Papillon site, which is becoming lower signal (arrows, D, E). Endoscopy demonstrated an ulcer at the previous tumor site, with palpable fibrosis (F). Unfortunately, at this time there was evidence of nodal recurrence on the MR image (arrow, G)