Colorectal Cancer Coalition

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Rectal stage II and III

For patients who are medically fit and able to undergo combined methods of therapy, treatment for stage II and III rectal cancer consists of

• Chemoradiation before surgery
• Abdominal surgery:  Low anterior resection (LAR) or abdominoperineal resection (APR)
• Adjuvant chemotherapy

Patients with medical issues that make chemoradiation difficult may go directly to surgery, followed by

• No further treatment if their tumor hasn’t spread through the rectal wall or to lymph nodes.
• A reconsideration of adjuvant chemotherapy and chemoradiation if there is spread through the wall (T3) or into lymph nodes (N1 or N2).

Neoadjuvant chemoradiation regimens

• Continuous infusion 5-FU and external beam radiation (EBRT).  Treatment usually lasts several weeks. With continuous infusion 5-FU, the chemotherapy drug is delivered intravenously through a pump carried in a fanny pack.
• Bolus 5-FU and external beam radiation.  Less often recommended.
• Oral Xeloda® (capecitabine) and radiation.
• A clinical trial that adds Eloxatin® (oxaliplatin) or Eloxatin plus Avastin® (bevacizumab) to Xeloda.

Adjuvant chemotherapy regimens after surgery

• 5-FU and leucovorin
• FOLFOX (oxaliplatin, leucovorin, continuous infusion 5-FU)
• oral Xeloda® (capecitabine)
• clinical trial

Adjuvant chemoradiation regimen

Adjuvant treatment is usually a “sandwich” of chemotherapy, chemoradiation, and additional chemotherapy.

• 5-FU with leucovorin or FOLFOX or Xeloda (capecitabine)
• radiotherapy with either continuous infusion 5-FU or Xeloda
• additional 5-FU with leucovorin or FOLFOX or Xeloda (capecitabine)

Last Update: January 9, 2009

Medical Review
Reviewed By: Joel Tepper, MD
Review Date: January 9, 2009