Patients With Rectal Cancer: a "Wait-and-see" Approach

Conditions de participation

• Sexe:

  ALL

• Âges admissibles:

  18 to 90

Critères de participation

Inclusion Criteria:

* 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

Exclusion Criteria:

* Previous radiotherapy to the pelvis (including brachytherapy)
* Enlarged extramesorectal nodes
* Uncontrolled cardiorespiratory comorbidity (includes patients with inadequately controlled angina or myocardial infarction within 6 months of randomisation)
* T1N0 disease without extra-mural venous invasion
* Unequivocal evidence of metastatic disease (includes resectable metastases)
* Major impairment of bowel function without defunctioning stoma/ileostomy (baseline grade 3 diarrhoea or clinically significant faecal incontinence)
* History of another malignancy within the last 5 years except successfully treated basal cell cancer of skin or carcinoma in situ of uterine cervix.
* Known dihydropyrimidine dehydrogenase deficiency
* Known Gilberts disease (hyperbilirubinaemia)
* Taking warfarin or phenytoin or sorivudine
* Gastrointestinal disorder which would interfere with oral therapy and its bioavailability
* Pregnant, lactating, or pre-menopausal women not using adequate contraception
* Unfit to receive any study treatment or subsequent surgical resection