Optimization of Preoperative Treatment in Locally Advanced Rectal Cancer (STELLAR)
Cancer, Rectum
About this trial
This is an interventional treatment trial for Cancer, Rectum focused on measuring rectal cancer, short-term radiotherapy, neoadjuvant chemotherapy, total mesorectal excision
Eligibility Criteria
Inclusion Criteria:
- Biopsy proven rectal adenocarcinoma;
- Distance between tumour and anal verge≤ 10cm;
- Locally advanced tumour;(AJCC Cancer Staging:T3, T4 or N+)
- Cancer Staging must be based on pelvic MRI;
- Eastern Cooperative Oncology Group(ECOG) performance score ≤ 1;
- Written informed consent;
- Mentally and physically fit for chemotherapy;
- Adequate blood counts: White blood cell count ≥3.5 x 109/L Haemoglobin levels ≥100g/L Platelet count ≥100 x 109/L Creatinine levels ≤1.0× upper normal limit(UNL) Urea nitrogen levels ≤1.0× upper normal limit(UNL) Alanine aminotransferase(ALT) ≤1.5× upper normal limit(UNL) Aspartate aminotransferase(AST) ≤1.5× upper normal limit(UNL) Alkaline phosphatase(ALP) ≤1.5× upper normal limit(UNL) Total bilirubin(TBIL) ≤1.5× upper normal limit(UNL)
- No excision of tumor, chemotherapy or other anti-tumor treatment after the diagnosis.
Exclusion Criteria:
- Distant metastases;
- Recurrent rectal cancer;
- Active Crohn's disease or ulcerative colitis;
- Concomitant malignancies;(except basocellular carcinoma or in-situ cervical carcinoma)
- Allergic to Fluorouracil or Platinum drugs;
- Contraindications to MRI for any reason;
- Concurrent uncontrolled medical condition;
- Pregnancy or breast feeding;
- Known malabsorption syndromes or lack of physical integrity of upper gastrointestinal tract;
- Symptoms or history of peripheral neuropathy
Sites / Locations
- Cancer Hospital, Chinese Academy of Medical Sciences, Peking Union Medical CollegeRecruiting
Arms of the Study
Arm 1
Arm 2
Experimental
Other
TNT group
CRT group
The intervention of TNT group is Short-course radiotherapy with neoadjuvant chemotherapy, which consists of a short-course radiotherapy (SCRT, 5 Gy x 5 alone), then after 7-10 days of radiotherapy completed, patients will receive neoadjuvant chemotherapy, given in 3 week cycle of capecitabine 1000 mg/m2 twice daily, day 1-14 combined with oxaliplatin 130 mg/m2 once. In total, 4 cycles of neoadjuvant chemotherapy are prescribed preoperatively, then followed by a total mesorectal excision(TME) and postoperative adjuvant chemotherapy. If patients are eligible for postoperative chemotherapy this should consist of at least 2 cycles, which are the same as neoadjuvant chemotherapy.
The intervention of CRT group is long-term chemoradiotherapy(CRT), which consists of a long-term chemoradiation (2 Gy x 25 with capecitabine) preoperatively, followed by a total mesorectal excision(TME) and then postoperative adjuvant chemotherapy. The radiotherapy is given in combination with capecitabine in a dose of 825 mg/m2 twice daily on days when radiotherapy, excluding weekends. If patients are eligible for postoperative chemotherapy this should consist of at least 6 cycles of capecitabine 1000 mg/m2 twice daily, day 1-14 combined with oxaliplatin 130 mg/m2 once every 3 weeks.