Treatment for Stage II Rectal Cancer

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

  • Chemoradiation before surgery
  • Abdominal surgery: Low anterior resection (LAR) or abdominoperineal resection (APR) – includes ostomy)
  • 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)
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