Radical External Beam Chemoradiation in Patients With Rectal Cancer: a Wait-and-see Approach
Patients with histologically proven adenocarcinoma of the rectum will receive pelvic radiotherapy to a dose of 45Gy in 25 fractions with a tumor boost to a dose of 9Gy in 5 fractions (thus total of 54Gy/30Fx to the primary tumor), combined with radio sensitizing chemotherapy. Patients will then be closely monitored, through endoscopy and imaging, for response to treatment and relapse. Salvage oncologic surgery to be offered if there is failure to achieve complete clinical response or in the event of a loco regional relapse.
• Pelvic MRI defined disease (at least one of the following):
‣ mesorectum involved or breached - includes involvement of adjacent organ (s) (T3-T4)
⁃ involvement of muscularis propria (T2)
⁃ extra-mural vascular invasion
⁃ tumour deposit within the mesorectum
⁃ one or more involved mesorectal lymph node
• Patients are considered medically fit for oncologic resection
• ECOG performance status 0 or 1
• No evidence of established metastatic disease (CT chest and abdomen)
• Absolute neutrophil count \>1.5x109/L; platelets \>100x109/L,
• Serum transaminase \<3 x ULN;
• Adequate renal function (Cockroft Gault estimation \>50 mL/min)
• Bilirubin \<1.5 x ULN
• Ability to comply with oral medication
• Willingness and ability to give informed consent and comply with treatment and follow up schedule
• Age 18 or over