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57

NCCN Guidelines for Patients

®

:

Rectal Cancer, Version 1.2017

5

Metastatic disease

Metastases at diagnosis

Guide 10. Surgical options

Option 1

Neoadjuvant

treatment

Primary treatment

Adjuvant treatment

• FOLFIRI

• FOLFOX

• CAPEOX

ª

• Transabdominal resection +

◦◦ Metastasectomy ± local

treatment or

◦◦ Local treatment

ª

Consider chemoradiation:

• Infusional 5-FU + pelvic radiation

• Capecitabine + pelvic radiation

• Bolus 5-FU/LV + pelvic radiation

Option 2

Neoadjuvant treatment

Primary treatment

Adjuvant

treatment

• FOLFIRI

• FOLFOX

• CAPEOX

ª

• Infusional 5-FU

+ radiation

• Capecitabine +

radiation

• Bolus 5-FU/LV

+ radiation

ª

• Transabdominal

resection +

◦◦ Metastasectomy ±

local treatment or

◦◦ Local treatment

ª

• Same as

neoadjuvant

chemotherapy

Option 3

Neoadjuvant treatment

Primary treatment

Adjuvant

treatment

• FOLFIRI

• FOLFOX

• CAPEOX

ª

• Short-course

pelvic radiation

for T1–T3

tumors

ª

• Transabdominal

resection +

◦◦ Metastasectomy ±

local treatment or

◦◦ Local treatment

ª

• Same as

neoadjuvant

chemotherapy

Option 4

Neoadjuvant treatment

Primary treatment

Adjuvant treatment

• Infusional 5-FU + pelvic radiation

• Capecitabine + pelvic radiation

• Bolus 5-FU/LV + pelvic radiation

ª

• Transabdominal

resection +

◦◦ Metastasectomy ±

local treatment or

◦◦ Local treatment

ª

• FOLFOX or

CAPEOX

• 5-FU/LV or

capecitabine

Option 5

Neoadjuvant treatment

Primary treatment

Adjuvant treatment

• Short-course pelvic

radiation therapy for

T1–T3 tumors

ª

• Transabdominal resection +

◦◦ Metastasectomy ± local

treatment or

◦◦ Local treatment

ª

• FOLFOX or CAPEOX

• 5-FU/LV or capecitabine