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)
