Chemotherapy (mFOLFOX) and Short-Course Radiotherapy for the Treatment of Resectable Rectal Cancer

Inclusion Criteria

• Pathologic diagnosis of adenocarcinoma of the rectum (diagnosis by tissue biopsy). At least a portion of the tumor must be located at or below the peritoneal reflection based on imaging or begin within 12 cm of the anal verge as seen on flexible endoscopy or imaging
• Clinically staged (AJCC 8th ed.) T3-4 N0 M0 or T any N1-2 M0 based upon the following minimum diagnostic workup: * Colonoscopy, unless patient presents with an obstructing lesion * Within 30 days prior to registration: ** History/physical examination ** Imaging to exclude distant metastases: either contrast-enhanced computed tomography (CT) of the chest, abdomen, and pelvis; or whole-body positron emission tomography (PET)-CT; or magnetic resonance imaging (MRI) ** Pelvic MRI (preferred) or transrectal ultrasound (TRUS) for T staging
• Eastern Cooperative Oncology Group (ECOG) performance status =< 1
• Age >= 18 years
• Absolute neutrophil count (ANC) >= 1,200 cells/mm^3
• Platelets >= 100,000 cells/mm^3
• Hemoglobin >= 8.0 g/dL (Note: The use of transfusion or other intervention to achieve Hgb >= 8.0 g/dL is acceptable)
• Aspartate aminotransferase (AST) and alkaline phosphatase < 2.5 x upper limit of normal (ULN)
• Bilirubin =< 2.5 ULN
• Calculated creatinine clearance (CrCl) > 30 mL/min using Cockcroft-Gault formula as calculated by the standard Cockcroft-Gault equation using age, actual weight, creatinine, and gender
• Must be deemed a candidate for curative resection by the surgical oncologist who will be performing the operation
• Women of childbearing potential (WCBP) must have a negative serum pregnancy test performed within 7 days prior to the start of chemotherapy
• WCBP and men must agree to use a medically accepted form of birth control during the treatment and for 3 months following completion of chemotherapy
• Ability to understand and the willingness to sign a written informed consent document

Exclusion Criteria

• Prior radiation therapy (RT) that would result in overlap of RT fields with the planned study treatment
• Clinically significant cardiac disease, including major cardiac dysfunction, that in the opinion of the treating medical oncologist would preclude them from receiving systemic therapy with 5-fluorouracil, leucovorin or oxaliplatin.
• Serious (i.e, >= grade 3) uncontrolled infection
• Pulmonary or respiratory condition that, in the opinion of the treating medical oncologist would preclude them from receiving systemic therapy with 5-fluorouracil, leucovorin or oxaliplatin
• Major surgery within 28 days of study enrollment (other than diverting colostomy)
• History of inflammatory bowel disease (e.g., Crohn’s disease, ulcerative colitis requiring significant intervention (e.g., hospitalization, surgery, immunosuppressive medications that would, in the opinion of the investigator, preclude study therapy
• Prior known allergic reaction to 5-FU, leucovorin or oxaliplatin
• Known dipyrimidine dehydrogenase deficiency (DPD)
• Any evidence of distant metastases (M1)
• Pregnant or breast feeding
• Medical, psychological, or social condition that, in the opinion of the investigator, may increase the patient’s risk or limit the patient’s adherence with study requirements