The addition of Oxaliplatin to conventionally fractionated chemoradiation (FULV or capecitabine) is considered as standard in unresectable rectal cancer by the panel of experts. The Investigators addressed the question whether short-course preoperative radiotherapy with consolidating chemotherapy of FOLFOX4 may increase the rate of R0 resection in patients with unresectable rectal cancer.
Patients with unresectable primary rectal cancer or with unresectable local recurrence without distant metastases are randomly allocated to control or experimental arm. The preoperative treatment in the control arm is conventionally fractionated chemoradiation with 50.4 Gy total dose in 28 fractions of 1.8 Gy over 5.5 weeks simultaneously with 5-Fu, leucovorin and oxaliplatin. Experimental group receive 25 Gy in 5 fractions of 5 Gy over 5 days and after one week interval - consolidating chemotherapy of 3 courses of FOLFOX4. Surgery should be curried out 10-11 weeks from beginning of radiation and at least 4 weeks from the last dose of fluorouracil or radiation. The study hypothesis is that the short-course preoperative radiotherapy with consolidating chemotherapy produce at least 10% increase of the rate of R0 resection compared to preoperative chemoradiation.
Study Type
INTERVENTIONAL
Allocation
RANDOMIZED
Purpose
TREATMENT
Masking
NONE
Enrollment
540
5 x 5 Gy and afer one week interval consolidating chemotherapy of 3 courses of FOLFOX4
28 x 1,8 Gy with simultaneous neoadjuvant chemotherapy: two courses of 5-Fu 325 mg/m2/day i.v. bolus and LV 20 mg/m2/day i.v.-bolus over 5 days given during 1-5 and 29-33 days of radiation. Oxaliplatin is given 50 mg/m2 once a week 5 times during 1, 8, 15, 22 and 29 days of radiation.
M. Sklodowska-Curie Memorial Cancer Centre
Warsaw, Poland
RECRUITINGThe rate of patients with R0 resection
Time frame: Surrogate endpoint available immediatly after surgery
Overall long-term survival
Time frame: 5 years
Progression-free long-term survival
Time frame: 5 years
The rate of local failures
Time frame: 5 years
The rate of distant metastases
Time frame: 5 years
The rate of early toxicity of neoadjuvant treatment according to the NCI CTCAE (version 3.0)
Time frame: 3 months
The rate of postoperative complications
Time frame: 30 days
The rate of late toxicity according to the RTOG/EORTC scale
Time frame: 5 years
The rate of complete pathological response
Time frame: Surrogate endpoint available immediatly after surgery
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