Colorectal Cancer Clinical Trial
Official title:
NEOadjuvant Chemotherapy Only Compared With Standard Treatment for Locally Advanced Rectal Cancer: a Randomized Phase II Trial
The main clinical hypothesis is that compared to radio-chemotherapy for low and mid rectal
tumors or surgery for high rectal tumors neoadjuvant chemotherapy reduces the rate of distant
relapse without increasing the rate of local relapse.
The aim of the present study is to compare long term and short term outcomes in rectal cancer
patients undergoing standard treatment (radio-chemotherapy/surgery) or experimental
neoadjuvant chemotherapy/surgery Furthermore, early surgical and medical complications, the
functional outcome, toxicity and quality of life (QoL) may be improved if radiotherapy can be
avoided.
Exploratory analyses are planned in order to find potential predictive markers for selecting
patients to either radio-chemotherapy/surgery or neoadjuvant combination
chemotherapy/surgery.
The standard treatment of locally advanced but resectable cancer in the middle or lower rectum is preoperative radio-chemotherapy and in the upper part initial surgery. The clinical benefit from radio-chemotherapy is primarily through a reduction in local relapse but the treatment is associated with acute toxicity and long term functional dysfunction. Subsequently, it is important to select patients with high risk of local relapse. Intense systemic combination chemotherapy reduces the risk of distant relapse and increases survival in the postoperative setting. The biological rationale is eradication of micrometastases and hence it may be anticipated that earlier, i.e. neoadjuvant, combination therapy may improve systemic control. ;
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