Treatment for Stage II and Stage III Rectal Cancer

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)
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