Abstract
SUMMARY
The current management of patients with clinically defined ‘locally advanced rectal cancer’ often involves fluoropyrimidine-based preoperative chemoradiotherapy (CRT) followed by total mesorectal excision. The focus remains primarily on reducing local recurrence, and improving survival, with organ preservation an increasing target. The best neoadjuvant CRT is the most effective regimen, balanced against the tolerability and late functional consequences, which should be selected for the individual according to their individual risk of local and distant recurrence. Hence, what makes the best neoadjuvant treatment depends on the activity and toxicity of the particular schedule, the aims of treatment, the individual disease characteristics and the individual patient pharmacogenomics. Current research efforts focus on enhancing the efficacy of CRT by integrating additional cytotoxics and biologically targeted agents.
References
- 1 Impact of T and N stage and treatment on survival and relapse in adjuvant rectal cancer: a pooled analysis. J. Clin. Oncol. 22(10), 1785–1796 (2004).
- 2 Improving adjuvant therapy of rectal cancer by combining protracted infusional fluorouracil with radiation therapy after curative surgery. N. Engl. J. Med. 331, 502–507 (1994).
- 3 . Local recurrence of rectal adenocarcinoma due to inadequate surgical resection: histopathological study of lateral tumour spread and surgical excision. Lancet 2(8514), 996–999 (1986).
- 4 MERCURY Study Group. Diagnostic accuracy of preoperative magnetic resonance imaging in predicting curative resection of rectal cancer: prospective observational study. BMJ 333(7572), 779 (2006).
- 5 . The Stockholm I trial of preoperative short term radiotherapy in operable rectal carcinoma. A prospective randomized trial. Stockholm Colorectal Cancer Study Group. Cancer 75(9), 2269–2275 (1995).
- 6 Stockholm Colorectal Cancer Study Group Randomized study on preoperative radiotherapy in rectal carcinoma. N. Engl. J. Med. 336, 980–987 (1997).
- 7 An Improved survival with preoperative radiotherapy in resectable rectal cancer Swedish Rectal Cancer Trial. Surg. Oncol. 3, 423–430 (1997).
- 8 Preoperative radiotherapy combined with total mesorectal excision for resectable rectal cancer. N. Engl. J. Med. 345(9), 638–646 (2001).
- 9 Preoperative radiotherapy versus selective postoperative chemoradiotherapy in patients with rectal cancer (MRC CR07 and NCIC-CTG C016): a multicentre, randomised trial. Lancet 373(9666), 811–820 (2009).
- 10 . Cooperative Clinical Investigators of the Dutch Colorectal Cancer Group. Macroscopic evaluation of rectal cancer resection specimen: clinical significance of the pathologist in quality control. J. Clin. Oncol. 20(7), 1729–1734 (2002).
- 11 MRC CR07/NCIC-CTG CO16 Trial Investigators; NCRI Colorectal Cancer Study Group. Effect of the plane of surgery achieved on local recurrence in patients with operable rectal cancer: a prospective study using data from the MRC CR07 and NCIC-CTG CO16 randomised clinical trial. Lancet 373(9666), 821–828 (2009).
- 12 Preoperative radiotherapy combined with total mesorectal excision for resectable rectal cancer: 12-year follow-up of the multicentre, randomised controlled TME trial. Lancet Oncol. 12, 575–582 (2011).
- 13 Preoperative versus postoperative chemoradiotherapy for rectal cancer. N. Engl. J. Med. 351(17), 1731–1740 (2004).
- 14 Chemotherapy with preoperative radiotherapy in rectal cancer. N. Engl. J. Med. 355(11), 1114–1123 (2006).
- 15 Preoperative radiotherapy with or without concurrent fluorouracil and leucovorin in T3–4 rectal cancers: results of FFCD 9203. J. Clin. Oncol. 24(28), 4620–4625 (2006).
- 16 Randomized Phase III study comparing preoperative radiotherapy with chemoradiotherapy in nonresectable rectal cancer. J. Clin. Oncol. 26(22), 3687–3694 (2008).
- 17 Adverse features on rectal MRI identify a high-risk group that may benefit from more intensive preoperative staging and treatment. Ann. Surg. Oncol. 19, 1199–1205 (2012).
- 18 The role of dual-time combined 18-fluorodeoxyglucose positron emission tomography and computed tomography in the staging and restaging workup of LARC, treated with preoperative chemoradiation therapy and radical surgery. Int. J. Radiat. Oncol. Biol. Phys. 74, 1461–1469 (2009).
- 19 Watch and wait approach following extended neoadjuvant chemoradiation for distal rectal cancer: are we getting closer to anal cancer management? Dis. Colon Rectum 56(10), 1109–1111 (2013).
- 20 FOLFOXIRI in combination with panitumumab as first-line treatment in quadruple wild-type (KRAS, NRAS, HRAS, BRAF) metastatic colorectal cancer patients: a Phase II trial by the Gruppo Oncologico Nord Ovest (GONO). Ann. Oncol. 24(8), 2062–2067 (2013).
- 21 Initial therapy with FOLFOXIRI and bevacizumab for metastatic colorectal cancer. N. Engl. J. Med. 371(17), 1609–1618 (2014).
- 22 Potential predictors of long-term survival after surgery for patients with stage IV colorectal cancer. Anticancer Res. 26(2B), 1377–1383 (2006).
- 23 The differential response to chemotherapy of ovarian metastases from colorectal cancer. Eur. J. Surg. Oncol. 34, 1335–1339 (2008).
- 24 Multicenter randomized Phase II clinical trial comparing neoadjuvant oxaliplatin, capecitabine, and preoperative radiotherapy with or without cetuximab followed by total mesorectal excision in patients with high-risk rectal cancer (EXPERT-C). J. Clin. Oncol. 30(14), 1620–1627 (2012).
- 25 Neoadjuvant chemotherapy without routine use of radiation therapy for patients with locally advanced rectal cancer: a pilot trial. J. Clin. Oncol. 32(6), 513–518 (2014).
- 26 The continuum of care: a paradigm for the management of metastatic colorectal cancer. Oncologist 12(1), 38–50 (2007).
- 27 Randomized trial of two induction chemotherapy regimens in metastatic colorectal cancer: an updated analysis. J. Natl Cancer Inst. 103(1), 21–30 (2011).
- 28 Determination of the optimal dose of 5-fluorouracil when combined with low dose D,L-leucovorin and irradiation in rectal cancer: results of three consecutive Phase II studies. EORTC Radiotherapy Group. Eur. J. Cancer 29A(10), 1406–1410 (1993).
- 29 Enhancement of radiation-induced downstaging of rectal cancer by fluorouracil and high dose leucovorin chemotherapy. J. Clin. Oncol. 10, 79–84 (1992).
- 30 Preoperative infusional chemoradiation therapy for stage T3 rectal cancer. Int. J. Radiat. Oncol. Biol. Phys. 32, 1025–1029 (1995).
- 31 The addition of continuous infusion 5-FU to preoperative radiation therapy increases tumour response, leading to increased sphincter preservation in locally advanced low rectal cancer. Int. J. Radiation Oncol. Biol. Phys. 57, 84–89 (2003).
- 32 Randomized Phase III trial in locally advanced rectal cancer: preoperative chemoradiotherapy with oral uracil and tegafur/leucovorin versus intravenous fluorouracil/leucovorin. Eur. J. Cancer 3/2(Suppl.), 172 (2005).
- 33 Comparison of the efficacy of oral capecitabine versus bolus 5-FU in preoperative radiotherapy of locally advanced rectal cancer. J. Korean Med. Sci. 21(1), 52–57 (2006).
- 34 Capecitabine vs continuous infusion 5-FU in neoadjuvant treatment of rectal cancer. A retrospective review. Int. J. Colorectal Dis. 23(2), 139–145 (2008).
- 35 Preoperative chemoradiotherapy for rectal cancer: randomized trial comparing oral uracil and tegafur and oral leucovorin vs. intravenous 5-fluorouracil and leucovorin. Int. J. Radiat. Oncol. Biol. Phys. 17, 102–110 (2008).
- 36 Capecitabine and oxaliplatin in the preoperative multimodality treatment of rectal cancer: surgical end points from national surgical adjuvant breast and bowel project trial R-04. J. Clin. Oncol. 32(18), 1927–1934 (2014).
- 37 Preferential activation of capecitabine in tumor following oral administration to colorectal cancer patients. Cancer Chemother. Pharmacol. 45, 291–297 (2000).
- 38 . Cellular pharmacology of fluorinated pyrimidines in vivo in man. Invest. New Drugs 7, 13–25 (1989).
- 39 Phase I trial evaluating the concurrent combination of radiotherapy and capecitabine in rectal cancer. J. Clin. Oncol. 20, 3983–3991 (2002).
- 40 A Phase I trial of preoperative radiotherapy and capecitabine for locally advanced, potentially resectable rectal cancer. Br. J. Cancer 91, 1019–1024 (2004).
- 41 Preoperative capecitabine with pelvic radiotherapy for locally advanced rectal cancer (Phase I trial). J. Med. Assoc. Thai. 89(11), 1874–1884 (2006).
- 42 Enhanced tomoricidal effect of chemotherapy with preoperative radiotherapy for rectal cancer: preliminary results of EORTC 22921. J. Clin. Oncol. 23, 5620–5627 (2005).
- 43 Long-term results of a randomised trial comparing preoperative short-course radiotherapy with preoperative conventionally fractionated chemoradiation for rectal cancer. Br. J. Surg. 93, 1215–1223 (2006).
- 44 Chemoradiotherapy with capecitabine versus fluorouracil for locally advanced rectal cancer: a randomised, multicentre, non-inferiority, Phase 3 trial. Lancet Oncol. 13(6), 579–588 (2012).
- 45 . Comparison of neoadjuvant oral chemotherapy with UFT plus Folinic acid or Capecitabine concomitant with radiotherapy on locally advanced rectal cancer. Rep. Pract. Oncol. Radiother. 17(6), 376–383 (2012).
- 46 Preoperative multimodality therapy improves disease-free survival in patients with carcinoma of the rectum: NSABP-R03. J. Clin. Oncol. 27, 5124–5130 (2009).
- 47 Sphincter preservation following preoperative radiotherapy for rectal cancer: report of a randomised trial comparing short-term radiotherapy vs. conventionally fractionated radiochemotherapy. Radiother. Oncol. 72(1), 15–24 (2004).
- 48 Neoadjuvant therapy for rectal cancer: mature results from NSABP protocol R-04. J. Clin. Oncol. 32, 2014 (Suppl. 3; abstract 390).
- 49 Phase I-II trial of cetuximab, capecitabine, oxaliplatin, and radiotherapy as preoperative treatment in rectal cancer. Int. J. Radiat. Oncol. Biol. Phys. 70, 1081–1086 (2008).
- 50 Can the histopathological assessment of the circumferential margin following pre-operative pelvic chemo-radiotherapy for T3/4 rectal cancer predict for three year disease free survival? Int. J. Radiat. Oncol. Biol. Phys. 63, 745–752 (2005).
- 51 A Phase I/II study of oxaliplatin when added to 5-fluorouracil and leucovorin and pelvic radiation in locally advanced rectal cancer: a colorectal clinical oncology group (CCOG) study. Br. J. Cancer 93, 993–998 (2005).
- 52 Polish Colorectal Study Group. Association between pathologic response in metastatic lymph nodes after preoperative chemoradiotherapy and risk of distant metastases in rectal cancer: an analysis of outcomes in a randomized trial. Int. J. Radiat. Oncol. Biol. Phys. 67(2), 369–377 (2007).
- 53 Irinotecan plus fluorouracil and leucovorin for metastatic colorectal cancer. Irinotecan Study Group. N. Engl. J. Med. 343(13), 905–914 (2000).
- 54 Irinotecan combined with fluorouracil compared with fluorouracil alone as first-line treatment for metastatic colorectal cancer: a multicentre randomised trial. Lancet 355, 1041–1047 (2000).
- 55 Mortalityassociated with irinotecan plus bolus fluorouracil/leucovorin:summary findingsof an independent panel. J. Clin. Oncol. 19, 3801–3807 (2001).
- 56 . SN-38, a metabolite of the camptothecin derivative CPT-11, potentiates the cytotoxic effect of radiation in human colon adenocarcinoma cells grown as spheroids. Radiother. Oncol. 43, 197–201 (1997).
- 57 . DNA topoisomerase I-targeting drugs as radiation sensitizers. Oncology (Williston Park) 13, 39–46 (1999).
- 58 Combined modality therapy of locally advanced or recurrent adenocarcinoma of the rectum: report of a Phase I/II trial of chemotherapy with CPT-11, 5- FU and concomitant irradiation. Proc. Am. Soc. Clin. Oncol. 19, 250a (Abstract 970) (2000).
- 59 Randomized Phase II study of neoadjuvant combined-modality chemoradiation for distal rectal cancer: Radiation Therapy Oncology Group Trial 0012. J. Clin. Oncol. 24, 650–655 (2006).
- 60 Neoadjuvant chemoradiation for distal rectal cancer: 5-year updated results of a randomized Phase 2 study of neoadjuvant combined modality chemoradiation for distal rectal cancer. Int. J. Radiat. Oncol. Biol. Phys. 86(3), 523–528 (2013).
- 61 Phase I trial of capecitabine and weekly irinotecan in combination with radiotherapy for neoadjuvant therapy of rectal cancer. J. Clin. Oncol. 23, 1350–1357 (2005).
- 62 Concurrent chemoradiation with capecitabine and weekly irinotecan as preoperative treatment for rectal cancer: results from a Phase I/II study. Br. J. Cancer 94(7), 976–981 (2006).
- 63 Preoperative downstaging chemoradiation with concurrent irinotecan and capecitabine in MRI-defined locally advanced rectal cancer: a Phase I trial (NWCOG-2). Br. J. Cancer 101, 924–934 (2009).
- 64 Preoperative chemoradiation with irinotecan and capecitabine in patients with locally advanced resectable rectal cancer: long-term results of a Phase II study. Int. J. Radiat. Oncol. Biol. Phys. 79, 1171–1178 (2011).
- 65 Preoperative chemoradiotherapy using concurrent capecitabine and irinotecan in magnetic resonance imaging-defined locally advanced rectal cancer: impact on long-term clinical outcomes. J. Clin. Oncol. 29(8), 1042–1049 (2011).
- 66 Phase II trial of preoperative 3D conformal radiotherapy protracted venous infusion 5-Fluorouracil, and weekly CPT 11, followed by surgery for ultrasound staged T3 rectal cancer. Int. J. Radiat. Oncol. Biol Phys. 55, 132–137 (2003).
- 67 Intensified concurrent chemoradiotherapy with 5-fluorouracil and irinotecan as neoadjuvant treatment in patients with locally advanced rectal cancer. Br. J. Cancer 92, 1215–1220 (2005).
- 68 A Phase II study of preoperative radiotherapy and concomitant weekly irinotecan in combination with protracted venous infusion 5-fluorouracil, for resectable locally advanced rectal cancer. Int. J. Radiat. Oncol. Biol. Phys. 66(1), 201–205 (2006).
- 69 A Phase I/IIstudy of irinotecan when added to 5-fluorouracil and leucovorin and pelvicradiation in locally advanced rectal cancer: a Colorectal Clinical OncologyGroup Study. Br. J. Cancer 96(4), 551–558 (2007).
- 70 Irinotecan+5-fluorouracil with concomitant pre-operative radiotherapy in locally advanced non-resectable rectal cancer: a Phase I/II study. Br. J. Cancer 98(7), 1210–1216 (2008).
- 71 A Phase II study of capecitabine and irinotecan in combination with concurrent pelvic radiotherapy (CapIri-RT) as neoadjuvant treatment of locally advanced rectal cancer. Br. J. Cancer 296, 912–917 (2007).
- 72 Radiation Therapy Oncology Group 0247: a randomized Phase II study of neoadjuvant capecitabine and irinotecan or capecitabine and oxaliplatin with concurrent radiotherapy for patients with locally advanced rectal cancer. Int. J. Radiat. Oncol. Biol. Phys. 82(4), 1367–1375 (2012).
- 73 Comparison of two preoperative chemoradiotherapy regimens for locally advanced rectal cancer: capecitabine alone versus capecitabine plus irinotecan. Radiat. Oncol. 8, 258 (2013).
- 74 Combined modality therapy of locally advanced or recurrent adenocarcinoma of the rectum: report of a Phase I trial of chemotherapy (CT) with CPT11, 5FU and concomitant irradiation (RT). J. Clin. Oncol. 20, 131a (2001).
- 75 Alliance for Clinical Trials in Oncology. Comparison of FOLFIRI with or without cetuximab in patients with resected stage III colon cancer; NCCTG (Alliance) Intergroup Trial N0147. Clin. Colorect. Cancer 13(2), 100–109 (2014).
- 76 Effect of oxaliplatin, fluorouracil, and leucovorin with or without cetuximab on survival among patients with resected stage III colon cancer: a randomized trial. JAMA 307(13), 1383–1393 (2012).
- 77 Bevacizumab plus oxaliplatin-based chemotherapy as adjuvant treatment for colon cancer (AVANT): a Phase 3 randomised controlled trial. Lancet Oncol. 13(12), 1225–1233 (2012).
- 78 ISRCTN Registry. ARISTOTLE: a Phase III trial comparing standard versus novel chemoradiation treatment (CRT) as pre-operative treatment for magnetic resonance imaging (MRI)-defined locally advanced rectal cancer. www.controlled-trials.com/ISRCTN
- 79 Superiority ofoxaliplatin and fluorouracil-leucovorin compared with either therapy alone inpatients with progressive colorectal cancer after irinotecan and fluorouracil-leucovorin:interim results of a Phase III trial. J. Clin. Oncol. 21, 2059–2069 (2003).
- 80 Leucovorin and fluorouracil with or without oxaliplatin as first line treatment in advanced colorectal cancer. J. Clin. Oncol. 18(16), 2938–2947 (2000).
- 81 Immunogenic death of colon cancer cells treated with oxaliplatin. Oncogene 29(4), 482–491 (2010).
- 82 Oxaliplatin combined with weekly bolus fluorouracil and leucovorin as surgical adjuvant chemotherapy for stage II and III colon cancer: results from NSABP C-07. J. Clin. Oncol. 25(16), 2198–2204 (2007).
- 83 Improved overall survival with oxaliplatin, fluorouracil, and leucovorin as adjuvant treatment in stage II or III colon cancer in the MOSAIC trial. J. Clin. Oncol. 27(19), 3109–3116 (2009).
- 84 Phase III trial of capecitabine plus oxaliplatin asadjuvant therapy for stage III colon cancer: a planned safety analysis in 1864patients. J. Clin. Oncol. 25, 102–109 (2007).
- 85 Bevacizumab in stage II-III colon cancer: 5-year update of the National Surgical Adjuvant Breast and Bowel Project C-08 trial. J. Clin. Oncol. 31(3), 359–364 (2013).
- 86 A Phase I-II study of weekly oxaliplatin, 5-fluorouracil continuous infusion and preoperative radiotherapy in locally advanced rectal cancer. Ann. Oncol. 16, 1140–1146 (2005).
- 87 A Phase I dose escalation study of continuous oral capecitabine in combination with oxaliplatin and pelvic radiation (XELOX-RT) in patients with locally advanced rectal cancer. Ann. Oncol. 17, 50–56 (2006).
- 88 Addition of oxaliplatin to continuous fluorouracil, l-folinic acid, and concomitant radiotherapy in rectal cancer: the Lyon R 97–03 Phase I trial. J. Clin. Oncol. 19, 2433–2438 (2001).
- 89 Groupe Digestif de la Fédération Nationale des Centres de Lutte Contre le Cancer. Combined radiotherapy, 5-fluorouracil continuous infusion and weekly oxaliplatin in advanced rectal cancer: a Phase I study. Eur. J. Cancer 41(18), 2861–2867 (2005).
- 90 Oxaliplatin combined with infusional 5-fluorouracil and concomitant radiotherapy in inoperable and metastatic rectal cancer: a Phase I trial. Br. J. Cancer 92, 655–661 (2005).
- 91 Addition of oxaliplatin to neo-adjuvant radiochemotherapy for irresectable rectal cancer, a Phase I study. Anticancer Res. 25, 629–633 (2005).
- 92 Phase I/II study of preoperative oxaliplatin, fluorouracil, and external-beam radiation therapy in patients with locally advanced rectal cancer: Cancer and Leukemia Group B 89901. J. Clin. Oncol. 24, 2557–2562 (2006).
- 93 Phase I study of preoperative radiation therapy with concurrent infusional 5-fluorouracil and oxaliplatin followed by surgery and postoperative 5-fluorouracil plus leucovorin for T3/T4 rectal adenocarcinoma: ECOG E1297. Int. J. Radiat. Oncol. Biol. Phys. 72, 108–113 (2008).
- 94 Phase I/II trial of capecitabine, oxaliplatin, and radiation for rectal cancer. J. Clin. Oncol. 21, 3098–3104 (2003).
- 95 A Phase I study of weekly intravenous oxaliplatin in combination with oral daily capecitabine and radiation therapy in the neoadjuvant treatment of rectal adenocarcinoma. Int. J. Radiat. Oncol. Biol. Phys. 65, 1462–1470 (2006).
- 96 Preoperative chemoradiotherapy with capecitabine and oxaliplatin in locally advanced rectal cancer. A Phase I-II multicenter study of the Dutch colorectal cancer group. Ann. Surg. Oncol. 14, 2773–2779 (2007).
- 97 Phase II study of preoperative oxaliplatin, capecitabine and external beam radiotherapy in patients with rectal cancer: the RadiOxCape study. Ann. Oncol. 16, 1898–1905 (2005).
- 98 Phase II study of weekly intravenous oxaliplatin combined with oral daily capecitabine and radiotherapy with biologic correlates in neoadjuvant treatment of rectal adenocarcinoma. Int. J. Radiat. Oncol. Biol. Phys. 72, 650–657 (2008).
- 99 Radiochemotherapy with short daily infusion of low-dose oxaliplatin, leucovorin, and 5-FU in T3-T4 unresectable rectal cancer: a Phase II IATTGI study. Int. J. Radiat. Oncol. Biol. Phys. 54, 397–402 (2002).
- 100 Preoperative chemoradiotherapy as neoadjuvant therapy for 35 patients with locally advanced lower rectal carcinoma. Zhonghua Wei Chang Wai Ke Za Zhi 8(2), 125–128 (2005).
- 101 Phase II study of neoadjuvant concurrent chemoradiotherapy with oxaliplatin-containing regimen in locally advanced rectal cancer. Front. Biosci. 11, 1275–1279 (2006).
- 102 Preoperative concurrent chemoradiotherapy in locally advanced rectal cancer with high-dose radiation and oxaliplatin-containing regimen: the Lyon R0–04 Phase II trial. J. Clin. Oncol. 21, 1119–1124 (2003).
- 103 Socrates Phase II study results: capecitabine (CAP) combined with oxaliplatin (OX) and preoperative radiation (RT) in patients (pts) with locally advanced rectal cancer (LARC). J. Clin. Oncol. 23(16s), 252 (Abstract 3527) (2005).
- 104 Comparison of two neoadjuvant chemoradiotherapy regimens for locally advanced rectal cancer: results of the Phase III trial accord 12/0405-Prodige 2. J. Clin. Oncol. 28(10), 1638–1644 (2010).
- 105 Primary tumor response to preoperative chemoradiation with or without oxaliplatin in locally advanced rectal cancer: pathologic results of the STAR-01 randomized Phase III trial. J. Clin. Oncol. 29(20), 2773–2780 (2011).
- 106 The impact of capecitabine and oxaliplatin in the preoperative multimodality treatment in patients with carcinoma of the rectum: NSABP R-04. NSABP R-04. J. Clin. Oncol. 29(Suppl.; Abstract 3503) (2011).
- 107 German Rectal Cancer Study Group. Preoperative chemoradiotherapy and postoperative chemotherapy with fluorouracil and oxaliplatin versus fluorouracil alone in locally advanced rectal cancer: initial results of the German CAO/ARO/AIO-04 randomised Phase 3 trial. Lancet Oncol. 13(7), 679–687 (2012).
- 108 Preoperative chemoradiotherapy and postoperative chemotherapy with capecitabine and oxaliplatin versus capecitabine alone in locally advanced rectal cancer: first results of the PETACC-6 randomized trial (abstract). J. Clin. Oncol. 31(Suppl.; Abstract 3531) (2013).
- 109 . Evaluation of early and late toxicities in chemoradiation trials. J. Clin. Oncol. 25, 4096–4103 (2007).
- 110 Factors associated with severe late toxicity after concurrent chemoradiation for locally advanced head and neck cancer: an RTOG analysis. J. Clin. Oncol. 26, 3582–3589 (2008).
- 111 Bevacizumab plus irinotecan, fluorouracil and leucovorin for metastatic colorectal cancer. N. Engl. J. Med. 350, 2335–2342 (2004).
- 112 Cetuximab and chemotherapy as initial treatment for metastatic colorectal cancer. N. Engl. J. Med. 360, 1408–1417 (2009).
- 113 Addition of aflibercept to fluorouracil, leucovorin, and irinotecan improves survival in a Phase III randomized trial in patients with metastatic colorectal cancer previously treated with an oxaliplatin-based regimen. J. Clin. Oncol. 30(28), 3499–3506 (2012).
- 114 Final results from PRIME: randomized Phase III study of panitumumab with FOLFOX4 for first-line treatment of metastatic colorectal cancer. Ann. Oncol. 25(7), 1346–1355 (2014).
- 115 Neoadjuvant bevacizumab, oxaliplatin, 5-fluorouracil, and radiation for rectal cancer. Int. J. Radiat. Oncol. Biol. Phys. 82, 124–129 (2012).
- 116 On behalf of the AVACROSS Study Group. Addition of bevacizumab to XELOX induction therapy plus concomitant capecitabine-based chemoradiotherapy in magnetic resonance imaging-defined poor-prognosis locally advanced rectal cancer: the AVACROSS Study. Oncologist 16(5), 614–620 (2011).
- 117 Multicenter randomized Phase II clinical trial comparing neoadjuvant oxaliplatin, capecitabine, and preoperative radiotherapy with or without cetuximab followed by total mesorectal excision in patients with high-risk rectal cancer (EXPERT-C). J. Clin. Oncol. 30(14), 1620–1627 (2012).
- 118 . The status of targeted agents in the setting of neoadjuvant radiation therapy in locally advanced rectal cancers. J. Gastrointest. Oncol. 4(3), 264–284 (2013).
- 119 RAS mutations and cetuximab in locally advanced rectal cancer: results of the EXPERT-C trial. Eur. J. Cancer. 50(8), 1430–1436 (2014).
- 120 . A meta-analysis of hyperfractionated and accelerated radiotherapy and combined chemotherapy and radiotherapy regimens in unresected locally advanced squamous cell carcinoma of the head and neck. BMC Cancer 8, 28 (2006).
- 121 . The absence of an adverse effect of prolongation of radiation treatment of primary rectal adenocarcinoma. Clin. Oncol. (R. Coll. Radiol.) 8(2), 97–101 (1996).
- 122 Prospective Phase II study of preoperativeshort-course radiotherapy for rectal cancer with twice daily fractions of 2.9Gy to a total dose of 29 Gy – long-term results. Radiat. Oncol. 4, 67 (2009).
- 123 Neoadjuvant chemoradiation versus hyperfractionated accelerated radiotherapy in locally advanced rectal cancer. Ann. Surg. Oncol. 14, 424–431 (2007).
- 124 A Phase II trial of neoadjuvant capecitabine combined with hyperfractionated accelerated radiation therapy in locally advanced rectal cancer. Am. J. Clin. Oncol. 33, 251–256 (2010).
- 125 Usefulness of two independent histopathological classifications of tumor regression in patients with rectal cancer submitted to hyperfractionated pre-operative radiotherapy. World J. Gastroenterol. 13, 515–524 (2007).
- 126 Preoperative short-term radiation therapy (25 Gy, 2.5 Gy twice daily) for primary resectable rectal cancer (Phase II). Br. J. Cancer 92, 1209–1214 (2005).
- 127 Short-course continuous, hyperfractionated, accelerated radiation therapy (CHART) as preoperative treatment for rectal cancer. Acta Oncol. 45, 1079–1085 (2006).
- 128 Neoadjuvant short-course hyperfractionated accelerated radiotherapy (SC-HART) combined with S-1 for locally advanced rectal cancer. J. Radiat. Res. 54(6), 1118–1124 (2013).
- 129 Preoperative short-course concurrent chemoradiation therapy followed by delayed surgery for locally advanced rectal cancer: a Phase 2 multicenter study (KROG 10-01). Int. J. Radiat. Oncol. Biol. Phys. 86(1), 34–39 (2013).
- 130 . Rectal and Anal Cancers: Conservative Treatment by Radiation- An Alternative to Surgery. Springer Verlag, NY, USA (1982).
- 131 . Dose-effect relationship in chemoradiotherapy for locally advanced rectal cancer: a randomized trial comparing two radiation doses. Int. J. Radiat. Oncol. Biol. Phys. 84(4), 949–954 (2012).
- 132 . Radiation dose-response model for locally advanced rectal cancer after preoperative chemoradiation therapy. Int. J. Radiat. Oncol. Biol. Phys. 85(1), 74–80 (2013).
- 133 Improved sphincter preservation in low rectal cancer with high dose preoperative radiotherapy: the Lyon R96–02 randomised trial. J. Clin. Oncol. 22, 2402–2409 (2004).
- 134 Conformal preoperative endorectal brachytherapy treatment for locally advanced rectal cancer: early results of a Phase I/II study. Dis. Colon Rectum 45, 1486–1493 (2002).
- 135 Chemoradiotherapy for rectal cancer: an updated analysis of factors affecting pathological response. Clin. Oncol. (R. Coll. Radiol.) 20(2), 176–183 (2008).
- 136 Long-term control of T2-T3 rectal adenocarcinoma with radiotherapy alone. Int. J. Radiat. Oncol. Biol. Phys. 54, 142–149 (2002).