Overview
The purpose of the study is to identify the most promising sequence of modalities in total neoadjuvant treatment of localy advanced rectal cancer with high risk of recurrence
Description
International recommendations for the treatment of LARC with a high risk of disease recurrence are inconsistent, regarding TNT. In Germain randomised study more pCR were achieved with consolidation chemotherapy. We will compare our standard approach (induction plus consolidation CT) with consolidation CT.
Eligibility
Inclusion Criteria:- histologically proven rectal adenocarcinoma
- no distant metastases on CT scan (M0 disease)
- at least one high risk factor for disease recurrence identified on MR imaging:
- T4 tumor (cT4)
- N2 disease (cN2)
- extramural venous invasion (cEMVI+)
- positive lateral lymph nodes
- distance of tumor to mesorectal fascia or positive lymph nodes is 1 mm or less (cMRF+)
- capacity for informed consent
- willingness to attend regular check-ups during and after treatment
Exclusion Criteria:history of previous irradiation in the pelvic area
- absolute contraindications for MR imaging
- distant metastases cannot be reliably excluded
- synchronous cancer
- chronic inflammatory bowel disease