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49

NCCN Guidelines for Patients

®

:

Rectal Cancer, Version 1.2017

4

Nonmetastatic cancer

Stages II and III

Not all treatment centers provide IORT. Instead, you

may receive external radiation, brachytherapy, or

both. These treatments can be started soon after

surgery.

Pathology and imaging

A pathologist will test the tissue removed during

surgery. He or she will assess the current extent of

the cancer in removed tissue. Based on test results,

a pathologic stage will be assigned.

Before adjuvant treatment, imaging is needed.

Imaging can show how well treatment worked.

CT scans of your chest, abdomen, and pelvis are

advised.

Systemic treatment

It is very rare but you may be unable to have surgery.

Surgery may not be possible because of where the

cancer is. Some health issues also exclude surgery.

Instead of surgery, you may receive treatment listed

in Part 6 excluding FOLFOXIRI.

Adjuvant treatment

After primary treatment, you may receive adjuvant

treatment. It is advised unless you had induction

Guide 7. Treatment options

Option 1

Neoadjuvant treatment

Primary treatment

Adjuvant treatment

Chemoradiation

• Capecitabine or

infusional 5-FU + long-

course radiation

• Bolus 5-FU/LV + long-

course radiation

ª

• Transabdominal resection

ª

• FOLFOX or CAPEOX

• 5-FU/LV or capecitabine

ª

• Systemic treatment in Part 6 if surgery isn’t an option

Option 2

Neoadjuvant treatment

Primary treatment

Induction chemotherapy

• FOLFOX or CAPEOX

• 5-FU/LV or capecitabine

ª

Chemoradiation

• Capecitabine or

infusional 5-FU + long-

course radiation

• Bolus 5-FU/LV + long-

course radiation

ª

• Transabdominal resection

ª

• Systemic treatment in Part 6

if surgery isn’t an option

Option 3 for T1–T3 tumors

Neoadjuvant treatment

Primary treatment

Adjuvant treatment

Radiation therapy

• Short-course radiation

ª

• Transabdominal resection

ª

• FOLFOX or CAPEOX

• 5-FU/LV or capecitabine

ª

• Systemic treatment in Part 6 if surgery isn’t an option