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The current landscape of locally advanced rectal cancer

Nature Reviews Clinical Oncology volume 8, pages 649–659 (2011)Cite this article

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Abstract

Postoperative adjuvant chemoradiotherapy was recommended as the standard treatment for patients with rectal cancer because it reduces local recurrence. This paradigm shifted with the use of neoadjuvant chemoradiotherapy, which not only reduces local recurrence but also improves sphincter preservation and surgical outcomes. However, the treatment of rectal carcinoma remains complicated. The accuracy of tumor staging can be compromised depending on the imaging modality used. The addition of modern chemotherapeutics and biologics to 5-fluorouracil as radiation sensitizers is questionable. Oxaliplatin as a radiation sensitizer has minimal effects on the pathologic complete response, but improves the radiographical response at the expense of an increased risk of toxicities. The role of biologics in addition to radiation therapy continues to be explored. Attention has focused on improving diagnostic imaging, radiation oncology, and surgical techniques, treatment regimens, and on exploring a role of molecular markers for patients with rectal cancers. We review the pivotal trials that have led to the current treatment paradigm for locally advanced rectal cancer and discuss novel methodologies that are being developed for the treatment of this prevalent malignancy.

Key Points

  • Preoperative chemoradiotherapy, followed by surgery and subsequent adjuvant chemotherapy, provides the best local disease control, sphincter preservation, and surgical outcomes in locally advanced rectal cancer (LARC)

  • Modern therapeutics, acting as radiation sensitizers, provide alternatives to the standard treatment with single agent 5-fluorouracil

  • Current limitations in approved chemotherapeutic agents such as oxaliplatin have led to an increased emphasis on improvements in diagnostic imaging, radiation oncology, surgical techniques, molecular markers, and treatment schema

  • Ongoing clinical trials explore new combinations of multimodality therapy that might enhance tumor regression, increase overall survival, and improve quality of life for patients with LARC

  • Continued attempts to research and modify the current treatment paradigm are necessary to advance new developments in the treatment of rectal cancer

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References

  1. American Cancer Society. Cancer Facts & Figures 2011. [online].

  2. Quirke, P., Durdey, P., Dixon, M. F. & Williams, N. S. Local recurrence of rectal adenocarcinoma due to inadequate surgical resection. Histopathological study of lateral tumour spread and surgical excisiaon. Lancet 2, 996–999 (1986).

    Article  CAS  Google Scholar 

  3. Bosset, J. F. et al. Chemotherapy with preoperative radiotherapy in rectal cancer. N. Engl. J. Med. 355, 1114–1123 (2006).

    Article  CAS  Google Scholar 

  4. Heald, R. J., Moran, B. J., Ryall, R. D., Sexton, R. & MacFarlane, J. K. Rectal cancer: the Basingstoke experience of total mesorectal excision, 1978–1997 Arch. Surg. 133, 894–899 (1998).

    Article  CAS  Google Scholar 

  5. Mortenson, M. M., Khatri, V. P., Bennett, J. J. & Petrelli, N. J. Total mesorectal excision and pelvic node dissection for rectal cancer: an appraisal. Surg. Oncol. Clin. N. Am. 16, 177–197 (2007).

    Article  Google Scholar 

  6. Quirke, P. et al. 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, 821–828 (2009).

    Article  Google Scholar 

  7. Balch, G. C., De Meo, A. & Guillem, J. G. Modern management of rectal cancer: a 2006 update. World J. Gastroenterol. 12, 3186–3195 (2006).

    Article  Google Scholar 

  8. Sauer, R. et al. Preoperative versus postoperative chemoradiotherapy for rectal cancer. N. Engl. J. Med. 351, 1731–1740 (2004).

    Article  CAS  Google Scholar 

  9. Brown, G. Thin section MRI in multidisciplinary pre-operative decision making for patients with rectal cancer. Br. J. Radiol. 78, S117–S127 (2005).

    Article  Google Scholar 

  10. Beets-Tan, R. G. et al. Accuracy of magnetic resonance imaging in prediction of tumour-free resection margin in rectal cancer surgery. Lancet 357, 497–504 (2001).

    Article  CAS  Google Scholar 

  11. Bissett, I. P. et al. Identification of the fascia propria by magnetic resonance imaging and its relevance to preoperative assessment of rectal cancer. Dis. Colon Rectum 44, 259–265 (2001).

    Article  CAS  Google Scholar 

  12. Schaffzin, D. M. & Wong, W. D. Endorectal ultrasound in the preoperative evaluation of rectal cancer. Clin. Colorectal Cancer 4, 124–132 (2004).

    Article  Google Scholar 

  13. Waizer, A. et al. Prospective comparative study of magnetic resonance imaging versus transrectal ultrasound for preoperative staging and follow-up of rectal cancer. Preliminary report. Dis. Colon Rectum 34, 1068–1072 (1991).

    Article  CAS  Google Scholar 

  14. Tio, T. L., Coene, P. P., van Delden, O. M. & Tytgat, G. N. Colorectal carcinoma: preoperative TNM classification with endosonography. Radiology 179, 165–170 (1991).

    Article  CAS  Google Scholar 

  15. Thaler, W. et al. Preoperative staging of rectal cancer by endoluminal ultrasound vs. magnetic resonance imaging. Preliminary results of a prospective, comparative study. Dis. Colon Rectum 37, 1189–1193 (1994).

    Article  CAS  Google Scholar 

  16. Engstrom, P. F. et al. NCCN Clinical Practice Guidelines in Oncology: rectal cancer. J. Natl Compr. Canc. Netw. 7, 838–881 (2009).

    Article  Google Scholar 

  17. den Dulk, M. et al. Risk factors for adverse outcome in patients with rectal cancer treated with an abdominoperineal resection in the total mesorectal excision trial. Ann. Surg. 246, 83–90 (2007).

    Article  Google Scholar 

  18. Martling, A., Holm, T., Johansson, H., Rutqvist, L. E. & Cedermark, B. The Stockholm II trial on preoperative radiotherapy in rectal carcinoma: long-term follow-up of a population-based study. Cancer 92, 896–902 (2001).

    Article  CAS  Google Scholar 

  19. Martling, A. et al. Impact of a surgical training programme on rectal cancer outcomes in Stockholm. Br. J. Surg. 92, 225–229 (2005).

    Article  CAS  Google Scholar 

  20. Cedermark, B., Johansson, H., Rutqvist, L. E. & Wilking, N. The Stockholm I trial of preoperative short term radiotherapy in operable rectal carcinoma. A prospective randomized trial. Stockholm Colorectal Cancer Study Group. Cancer 75, 2269–2275 (1995).

    Article  CAS  Google Scholar 

  21. Fleshman, J. W. et al. Early results of laparoscopic surgery for colorectal cancer. Retrospective analysis of 372 patients treated by Clinical Outcomes of Surgical Therapy (COST) Study Group. Dis. Colon Rectum 39, S53–S58 (1996).

    Article  CAS  Google Scholar 

  22. Franklin, M. E. Jr et al. Prospective comparison of open vs. laparoscopic colon surgery for carcinoma. Five-year results. Dis. Colon Rectum 39, S35–S46 (1996).

    Article  Google Scholar 

  23. Jayne, D. G. et al. Randomized trial of laparoscopic-assisted resection of colorectal carcinoma: 3-year results of the UK MRC CLASICC Trial Group. J. Clin. Oncol. 25, 3061–3068 (2007).

    Article  Google Scholar 

  24. Fleshman, J. et al. Laparoscopic colectomy for cancer is not inferior to open surgery based on 5-year data from the COST Study Group trial. Ann. Surg. 246, 655–662 (2007).

    Article  Google Scholar 

  25. US National Library of Medicine. ClinicalTrials.gov. [online] (2011).

  26. Ahmed, K. et al. Current status of robotic assisted pelvic surgery and future developments. Int. J. Surg. 7, 431–440 (2009).

    Article  Google Scholar 

  27. US National Library of Medicine. ClinicalTrials.gov. [online] (2010).

  28. Dahl, O. et al. Low-dose preoperative radiation postpones recurrences in operable rectal cancer. Results of a randomized multicenter trial in western Norway. Cancer 66, 2286–2294 (1990).

    Article  CAS  Google Scholar 

  29. Gérard, A. et al. Preoperative radiotherapy as adjuvant treatment in rectal cancer. Final results of a randomized study of the European Organization for Research and Treatment of Cancer (EORTC). Ann. Surg. 208, 606–614 (1988).

    Article  Google Scholar 

  30. Folkesson, J. et al. Swedish Rectal Cancer Trial: long lasting benefits from radiotherapy on survival and local recurrence rate. J. Clin. Oncol. 23, 5644–5650 (2005).

    Article  Google Scholar 

  31. Goldberg, P. A., Nicholls, R. J., Porter, N. H., Love, S. & Grimsey, J. E. Long-term results of a randomised trial of short-course low-dose adjuvant pre-operative radiotherapy for rectal cancer: reduction in local treatment failure. Eur. J. Cancer 30A, 1602–1606 (1994).

    Article  CAS  Google Scholar 

  32. Kapiteijn, E. et al. Preoperative radiotherapy combined with total mesorectal excision for resectable rectal cancer. N. Engl. J. Med. 345, 638–646 (2001).

    Article  CAS  Google Scholar 

  33. Marsh, P. J., James, R. D. & Schofield, P. F. Adjuvant preoperative radiotherapy for locally advanced rectal carcinoma. Results of a prospective, randomized trial. Dis. Colon Rectum 37, 1205–1214 (1994).

    Article  CAS  Google Scholar 

  34. Randomised trial of surgery alone versus radiotherapy followed by surgery for potentially operable locally advanced rectal cancer. Medical Research Council Rectal Cancer Working Party. Lancet 348, 1605–1610 (1996).

  35. Peeters, K. C. et al. The TME trial after a median follow-up of 6 years: increased local control but no survival benefit in irradiated patients with resectable rectal carcinoma. Ann. Surg. 246, 693–701 (2007).

    Article  Google Scholar 

  36. Preoperative short-term radiation therapy in operable rectal carcinoma. A prospective randomized trial. Stockholm Rectal Cancer Study Group. Cancer 66, 49–55 (1990).

  37. Improved survival with preoperative radiotherapy in resectable rectal cancer. Swedish Rectal Cancer Trial. N. Engl. J. Med. 336, 980–987 (1997).

  38. Peeters, K. C. et al. Late side effects of short-course preoperative radiotherapy combined with total mesorectal excision for rectal cancer: increased bowel dysfunction in irradiated patients—a Dutch colorectal cancer group study. J. Clin. Oncol. 23, 6199–6206 (2005).

    Article  CAS  Google Scholar 

  39. Stephens, R. J. et al. Impact of short-course preoperative radiotherapy for rectal cancer on patients' quality of life: data from the Medical Research Council CR07/National Cancer Institute of Canada Clinical Trials Group C016 randomized clinical trial. J. Clin. Oncol. 28, 4233–4239.

  40. Prolongation of the disease-free interval in surgically treated rectal carcinoma. Gastrointestinal Tumor Study Group. N. Engl. J. Med. 312, 1465–1472 (1985).

  41. Krook, J. E. et al. Effective surgical adjuvant therapy for high-risk rectal carcinoma. N. Engl. J. Med. 324, 709–715 (1991).

    Article  CAS  Google Scholar 

  42. NIH consensus conference. Adjuvant therapy for patients with colon and rectal cancer. JAMA 264, 1444–1450 (1990).

  43. Bosset, J.F. et al. Enhanced tumorocidal effect of chemotherapy with preoperative radiotherapy for rectal cancer: preliminary results—EORTC 22921. J. Clin. Oncol. 23, 5620–5627 (2005).

    Article  CAS  Google Scholar 

  44. Gérard, J. P. et al. Preoperative radiotherapy with or without concurrent fluorouracil and leucovorin in T3–4 rectal cancers: results of FFCD 9203. J. Clin. Oncol. 24, 4620–4625 (2006).

    Article  Google Scholar 

  45. Bujko, K. et al. Long-term results of a randomized trial comparing preoperative short-course radiotherapy with preoperative conventionally fractionated chemoradiation for rectal cancer. Br. J. Surg. 93, 1215–1223 (2006).

    Article  CAS  Google Scholar 

  46. Bujko, K. et al. Sphincter preservation following preoperative radiotherapy for rectal cancer: report of a randomised trial comparing short-term radiotherapy vs. conventionally fractionated radiochemotherapy. Radiother. Oncol. 72, 15–24 (2004).

    Article  CAS  Google Scholar 

  47. Nissan, A. et al. Predictors of recurrence in patients with T2 and early T3, N0 adenocarcinoma of the rectum treated by surgery alone. J. Clin. Oncol. 24, 4078–4084 (2006).

    Article  Google Scholar 

  48. Rödel, C. et al. Prognostic significance of tumor regression after preoperative chemoradiotherapy for rectal cancer. J. Clin. Oncol. 24, 1319 (2005).

    Google Scholar 

  49. Fietkau, R. et al. Rectal cancer delivery of radiotherapy in adequate time and with adequate dose is influenced by treatment center, treatment schedule, and gender and is prognostic parameter for local control: results of study CAO/ARO/AIO-94. Int. J. Radiat. Oncol. Biol. Phys. 67, 1008–1019 (2007).

    Article  Google Scholar 

  50. Roh, M. S. et al. Preoperative multimodality therapy improves disease-free survival in patients with carcinoma of the rectum: NSABP R-03. J. Clin. Oncol. 27, 5124–5130 (2009).

    Article  Google Scholar 

  51. Pietrzak, L. et al. Quality of life, anorectal and sexual functions after preoperative radiotherapy for rectal cancer: report of a randomised trial. Radiother. Oncol. 84, 217–225 (2007).

    Article  Google Scholar 

  52. Thong, M. S. et al. Impact of preoperative radiotherapy on general and disease-specific health status of rectal cancer survivors: a population-based study. Int. J. Radiat. Oncol. Biol. Phys. doi:10.1016/j.ijrobp.2010.12.030.

  53. O'Connell, M. J. et al. Improving adjuvant therapy for rectal cancer by combining protracted-infusion fluorouracil with radiation therapy after curative surgery. N. Engl. J. Med. 331, 502–507 (1994).

    Article  CAS  Google Scholar 

  54. Desai, S. P. et al. A phase II study of preoperative capecitabine and radiation therapy in patients with rectal cancer. Am. J. Clin. Oncol. 30, 340–345 (2007).

    Article  Google Scholar 

  55. Kim, J. C. et al. Preoperative concurrent radiotherapy with capecitabine before total mesorectal excision in locally advanced rectal cancer. Int. J. Radiat. Oncol. Biol. Phys. 63, 346–353 (2005).

    Article  CAS  Google Scholar 

  56. Hofheinz, R et al. Capecitabine (Cape) versus 5-fluorouracil (5-FU)-based (neo-) adjuvant chemoradiotherapy (CRT) for locally advanced rectal cancer (LARC): Long-term results of a randomized, phase III trial [abstract]. J. Clin. Oncol. 29 (18 Suppl.), 3504 (2011).

    Article  Google Scholar 

  57. Roh, M. et al. The impact of capecitabine and oxaliplatin in the preoperative multimodality treatment in patients with carcinoma of the rectum: NSABP R-04 [abstract]. J. Clin. Oncol. 29 (18 Suppl.), 3503 (2011).

    Article  Google Scholar 

  58. Rödel, C. et al. Multicenter phase II trial of chemoradiation with oxaliplatin for rectal cancer. J. Clin. Oncol. 25, 110–117 (2007).

    Article  Google Scholar 

  59. Aschele C. et al. 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, 2773–2780 (2011).

    Article  CAS  Google Scholar 

  60. Gérard, J et al. Randomized multicenter phase III trial comparing two neoadjuvant chemoradiotherapy (CT-RT) regimens (RT45-Cap versus RT50-Capox) in patients (pts) with locally advanced rectal cancer (LARC): results of the ACCORD 12/0405 PRODIGE 2 [abstract]. J. Clin. Oncol. 28 (18 Suppl.), LBA4007 (2009).

    Article  Google Scholar 

  61. Machiels, J. P. et al. Phase I/II study of preoperative cetuximab, capecitabine, and external beam radiotherapy in patients with rectal cancer. Ann. Oncol. 18, 738–744 (2007).

    Article  Google Scholar 

  62. Eisterer W.M. et al. Neodajuvant chemoradiation therapy with capecitabine (X) plus cetuximab (C), and external beam radiotherapy (RT) in locally advanced rectal cancer (LARC): ABCSG trial R03 [abstract]. J. Clin. Oncol. 27 (15 Suppl.), 4109 (2009).

    Google Scholar 

  63. Rödel, C. et al. 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).

    Article  Google Scholar 

  64. Willett, C. G. et al. Efficacy, safety, and biomarkers of neoadjuvant bevacizumab, radiation therapy, and fluorouracil in rectal cancer: a multidisciplinary phase II study. J. Clin. Oncol. 27, 3020–3026 (2009).

    Article  CAS  Google Scholar 

  65. Crane, C. H. et al. Phase II trial of neoadjuvant bevacizumab (BEV), Capecitabine (CAP), and radiotherapy (XRT) for locally advanced rectal cancer. Int. J. Radiat. Oncol. Biol. Phys. 76, 824–830 (2010).

    Article  CAS  Google Scholar 

  66. Czito, B. G. et al. Bevacizumab, oxaliplatin, and capecitabine with radiation therapy in rectal cancer: Phase I trial results. Int. J. Radiat. Oncol. Biol. Phys. 68, 472–478 (2007).

    Article  CAS  Google Scholar 

  67. Dipetrillo, T. et al. Neoadjuvant bevacizumab, oxaliplatin, 5-fluorouracil, and radiation for rectal cancer. Int. J. Radiat. Oncol. Biol. Phys. doi:10.1016/j.ijrobp.2010.08.005.

  68. Saif, M. W., Hashmi S., Zelterman D., Almhanna K. & Kim R. Capecitabine vs continuous infusion 5-FU in neoadjuvant treatment of rectal cancer. A retrospective review. Int. J. Colorectal. Dis. 23, 139–45 (2007).

    Article  Google Scholar 

  69. Blaszkowsky LS. et al. A phase I/II study of bevacizumab (beva), erlotinib (erl), and 5-fluorouracil (5-FU) with concurrent external beam radiation therapy (RT) in locally advanced rectal cancer (LARC) [abstract]. J. Clin. Oncol. 27 (15 Suppl.), 4106 (2009).

    Google Scholar 

  70. US National Library of Medicine. ClinicalTrials.gov [online]. (2011).

  71. US National Library of Medicine. ClinicalTrials.gov [online]. (2009).

  72. US National Library of Medicine. ClinicalTrials.gov [online]. (2009).

  73. US National Library of Medicine. ClinicalTrials.gov [online]. (2009).

  74. US National Library of Medicine. ClinicalTrials.gov [online]. (2011).

  75. Chua, Y. J. et al. Neoadjuvant capecitabine and oxaliplatin before chemoradiotherapy and total mesorectal excision in MRI-defined poor-risk rectal cancer: a phase 2 trial. Lancet Oncol. 11, 241–248 (2010).

    Article  CAS  Google Scholar 

  76. Fernandez-Martos, C. et al. Three-year outcomes of GCR-3: a phase II randomized trial comparing conventional preoperative chemoradiation (CRT) followed by surgery and postoperative adjuvant chemotherapy (CT) with induction CT followed by CRT and surgery in locally advanced rectal cancer [abstract]. J. Clin. Oncol. 29 (18 Suppl.), 3552 (2011).

    Article  Google Scholar 

  77. Dewdney, A. et al. EXPERT-C: A randomized phase II European multicenter trial of neoadjuvant chemotherapy (capecitabine/oxaliplatin) and chemoradiation (CRT) with or without cetuximab followed by total mesorectal excision (TME) in patients with MRI-defined high-risk rectal cancer [abstract]. J. Clin. Oncol. 29 (4 Suppl.), 360 (2011).

    Article  Google Scholar 

  78. Steele, G. D. Jr. et al. Sphincter-sparing treatment for distal rectal adenocarcinoma. Ann. Surg. Oncol. 6, 433–441 (1999).

    Article  Google Scholar 

  79. Garcia-Aguilar J. et al. Pathologic complete response (pCR) to neoadjuvant chemoradiation (CRT) of uT2uN0 rectal cancer (RC) treated by local excision (LE): Results of the ACOSOG Z6041 trial [abstract]. J. Clin. Oncol. 28 (15 Suppl.), 3510 (2010).

    Article  Google Scholar 

  80. Schrag, D. et al. Neoadjuvant FOLFOX-bev, without radiation, for locally advanced rectal cancer. J. Clin. Oncol. 28 (15 Suppl.), 3511 (2010).

    Article  Google Scholar 

  81. US National Library of Medicine. ClinicalTrials.gov [online]. (2009).

  82. Eng C., Abbruzzese J. & Minsky B. D. Chemotherapy and radiation of anal canal cancer: the first approach. Surg. Oncol. N. Am. 13, 309–320 (2004).

    Article  Google Scholar 

  83. Kachnic L. A. et al. Two-year outcomes of RTOG 0529: A phase II evaluation of dose-painted IMRT in combination with 5-fluorouracil and mitomycin-C for the reduction of acute morbidity in carcinoma of the anal canal [abstract]. J. Clin. Oncol. 29 (4 Suppl.), 368 (2011).

    Article  Google Scholar 

  84. Habr-Gama, A. Assessment and management of the complete clinical response of rectal cancer to chemoradiotherapy. Colorectal Dis. 8, 21–24 (2006).

    Article  Google Scholar 

  85. Bedrosian I et al. Genomic profiling of pathologic complete response in locally advanced rectal cancer. J. Am. Coll. Surg. 209, S50–S51 (2009).

    Article  Google Scholar 

  86. US National Library of Medicine. ClinicalTrials.gov [online]. (2009).

  87. Wolpin, B. M., Meyerhardt, J. A., Mamon, H. J. & Mayer, R. J. Adjuvant treatment of colorectal cancer. CA Cancer J. Clin. 57, 168–185 (2007).

    Article  Google Scholar 

  88. Turitto, G. et al. Phase II study of neoadjuvant concurrent chemioradiotherapy with oxaliplatin-containing regimen in locally advanced rectal cancer. Front. Biosci. 11, 1275–1279 (2006).

    Article  CAS  Google Scholar 

  89. Dolinsky, C.M. et al. Evidence for improved pathologic complete response (PCR) rate after preoperative chemoradiotherapy with 5-FU/oxaliplatin (5FU/OX) for rectal cancer [abstract]. J. Clin. Oncol. 24 (18 Suppl.), 3567 (2006).

    Google Scholar 

  90. Rutten, H. et al. Capecitabine, oxaliplatin, radiotherapy, and excision (CORE) in patients with MRI-defined locally advanced rectal adenocarcinom: Results of an international multicenter phase II study [abstract]. J. Clin. Oncol. 24 (18 Suppl.), 3528 (2006).

    Google Scholar 

  91. Alonso, V., Salud, A. & al., E. Preoperative chemoradiation therapy with capecitabine and oxaliplatin in locally advanced rectal carcinoma: a phase II trial [abstract]. J. Clin. Oncol. 25 (18 Suppl.), 4044 (2007).

    Google Scholar 

  92. Willeke, F. et al. 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 96, 912–917 (2007).

    Article  CAS  Google Scholar 

  93. US National Library of Medicine. ClinicalTrials.gov [online]. (2010).

  94. US National Library of Medicine. ClinicalTrials.gov [online]. (2010).

  95. Hofheinz, R. D. et al. Phase I trial of cetuximab in combination with capecitabine, weekly irinotecan, and radiotherapy as neoadjuvant therapy for rectal cancer. Int. J. Radiat. Oncol. Biol. Phys. 66, 1384–1390 (2006).

    Article  CAS  Google Scholar 

  96. Pinto C et al. Phase II study of panitumumab, oxaliplatin, 5-fluorouracil, and concurrent radiotherapy as preoperative treatment in high-risk locally advanced rectal cancer patients (StarPan/STAR-02 Study). Ann. Oncol. doi:10.1093/annonc/mdq782.

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C. P. Vega, University of California, Irvine, CA, is the author of and is solely responsible for the content of the learning objectives, questions and answers of the Medscape, LLC-accredited continuing medical education activity associated with this article.

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  1. Department of Gastrointestinal Medical Oncology, MD Anderson Cancer Center, 1515 Holcombe Boulevard, Unit 426, Houston, 77030, TX, USA

    Mebea Aklilu & Cathy Eng

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C. Eng is a consultant for Genentech and has received grant/research support from the company. M. Aklilu declares no competing interests.

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Aklilu, M., Eng, C. The current landscape of locally advanced rectal cancer. Nat Rev Clin Oncol 8, 649–659 (2011). https://doi.org/10.1038/nrclinonc.2011.118

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