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Section editor transclusions Are you looking for a regimen but can't find it here? For placebo or observational studies in this condition, please visit this page. If you still can't find it, please let us know so we can add it!
Note: the page has regimens specific to rectal cancer. Please see the colon cancer page for regimens specific to colon cancer (e.g., adjuvant CapeOx) and the colorectal cancer page for regimens intended more generically for colorectal cancer.

22 regimens on this page 48 variants on this page

Guidelines

ESMO

2017: Glynne-Jones et al. Rectal cancer: ESMO Clinical Practice Guidelines for diagnosis, treatment and follow-up
- 2018 addendum

Older

2013: Glimelius et al. Rectal cancer: ESMO Clinical Practice Guidelines for diagnosis, treatment and follow-up PubMed

NCCN

NCCN Guidelines - Rectal Cancer

SIOG

2018: Montroni, Isacco et al. Personalized management of elderly patients with rectal cancer: Expert recommendations of the European Society of Surgical Oncology, European Society of Coloproctology, International Society of Geriatric Oncology, and American College of Surgeons Commission on Cancer.

Neoadjuvant therapy

Capecitabine & RT

Capecitabine & RT: Capecitabine & Radiation Therapy

Regimen variant #1, interrupted capecitabine, 1600 mg/m²/day, 45 Gy

Study	Years of enrollment	Evidence	Comparator	Comparative Efficacy
Gérard et al. 2010 (ACCORD 12/0405 PRODIGE 2)	2005-2008	Phase 3 (C)	CapeOx & RT	Might have inferior pCR rate

Note: adjuvant therapy was not specified. Treatment is assumed to start on a Monday.

Chemotherapy

Capecitabine (Xeloda) 800 mg/m² PO twice per day on days 1 to 5

7-day cycle for 5 cycles

Radiotherapy

Concurrent radiation therapy, 45 Gy total in 25 fractions

5-week course

Subsequent treatment

Surgery

Regimen variant #2, interrupted capecitabine, 1600 mg/m²/day, 50 Gy

Study	Years of enrollment	Evidence
Conroy et al. 2021 (UNICANCER-PRODIGE 23)	2012-2017	Non-randomized portion of RCT

Note: Treatment is assumed to start on a Monday.

Preceding treatment

FOLFIRINOX versus no neoadjuvant chemotherapy

Chemotherapy

Capecitabine (Xeloda) 800 mg/m² PO twice per day on days 1 to 5

7-day cycle for 5 cycles

Radiotherapy

Concurrent radiation therapy, 50 Gy total in 25 fractions

5-week course

Subsequent treatment

TME, then mFOLFOX6

Regimen variant #3, interrupted capecitabine, 1650 mg/m²/day, 45 Gy

Study	Years of enrollment	Evidence	Comparator	Comparative Efficacy
Schmoll et al. 2020 (PETACC 6)	2008-2011	Phase 3 (C)	CapeOx & RT	Did not meet primary endpoint of DFS36

Note: Treatment starts on a Monday.

Chemotherapy

Capecitabine (Xeloda) 825 mg/m² PO twice per day on days 1 to 5

7-day cycle for 5 cycles

Radiotherapy

Concurrent radiation therapy, 45 Gy total in 25 fractions

5-week course

Subsequent treatment

Surgery, then adjuvant capecitabine

Regimen variant #4, continuous capecitabine, 1650 mg/m²/day, 45 Gy

Study	Years of enrollment	Evidence	Comparator	Comparative Efficacy	Comparative Toxicity
Hofheinz et al. 2012 (Rektum-III)	2002-2007	Phase 3 (E-switch-ic)	5-FU & RT	Non-inferior OS
Park et al. 2011 (AMC Rectal Pre Vs Post 2004)	2004-2006	Phase 3 (E-switch-ic)	Capecitabine & RT; adjuvant	Did not meet primary endpoint of DFS36	Superior sphincter preservation
O'Connell et al. 2014 (NSABP R-04)	2004-2010	Phase 3 (E-switch-ic)	1. 5-FU & RT	Did not meet primary endpoint of LRC	Similar toxicity
O'Connell et al. 2014 (NSABP R-04)	2004-2010	Phase 3 (E-switch-ic)	2. CapeOx & RT 3. FUOX & RT	Did not meet primary endpoint of LRC	Superior toxicity
Valentini et al. 2016 (INTERACT)	2005-2013	Phase 3 (C)	CapeOx & RT	Did not meet efficacy endpoints	Superior toxicity

Chemotherapy

Capecitabine (Xeloda) 825 mg/m² PO twice per day on days 1 to 38

Radiotherapy

Concurrent radiation therapy, 1.8 Gy for 25 fractions (45 Gy), with boost depending on stage

5.5-week course

Subsequent treatment

Surgery, then adjuvant capecitabine

Regimen variant #5, interrupted capecitabine, 1650 mg/m²/day, 50 Gy

Study	Years of enrollment	Evidence	Comparator	Comparative Efficacy
Zhu et al. 2020 (CinClare)	2015-2017	Phase 3 (C)	See link	See link

Note: Treatment is assumed to start on a Monday. Surgery is to take place 8 weeks after completion of chemoradiotherapy.

Chemotherapy

Capecitabine (Xeloda) 825 mg/m² PO twice per day on days 1 to 5

7-day cycle for 5 cycles

Radiotherapy

Concurrent radiation therapy, 50 Gy total in 25 fractions

5-week course

Subsequent treatment

CapeOx x 1, then TME, then CapeOx x 5

Regimen variant #6, interrupted capecitabine, 1650 mg/m²/day, 50.4 Gy

Study	Years of enrollment	Evidence	Comparator	Comparative Efficacy
Schmoll et al. 2020 (PETACC 6)	2008-2011	Phase 3 (C)	CapeOx & RT	Did not meet primary endpoint of DFS36

Note: Treatment starts on a Monday.

Chemotherapy

Capecitabine (Xeloda) 825 mg/m² PO twice per day on days 1 to 5

7-day cycle for 5.5 cycles

Radiotherapy

Concurrent radiation therapy, 50.4 Gy total in 28 fractions (1.8 Gy per fraction)

5.5-week course

Subsequent treatment

Surgery, then adjuvant capecitabine

References

ACCORD 12: Gérard JP, Azria D, Gourgou-Bourgade S, Martel-Laffay I, Hennequin C, Etienne PL, Vendrely V, François E, de La Roche G, Bouché O, Mirabel X, Denis B, Mineur L, Berdah JF, Mahé MA, Bécouarn Y, Dupuis O, Lledo G, Montoto-Grillot C, Conroy T. 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. 2010 Apr 1;28(10):1638-44. Epub 2010 Mar 1. link to original article contains dosing details in manuscript PubMed NCT00227747
1. Update: Gérard JP, Azria D, Gourgou-Bourgade S, Martel-Lafay I, Hennequin C, Etienne PL, Vendrely V, François E, de La Roche G, Bouché O, Mirabel X, Denis B, Mineur L, Berdah JF, Mahé MA, Bécouarn Y, Dupuis O, Lledo G, Seitz JF, Bedenne L, Juzyna B, Conroy T. Clinical outcome of the ACCORD 12/0405 PRODIGE 2 randomized trial in rectal cancer. J Clin Oncol. 2012 Dec 20;30(36):4558-65. Epub 2012 Oct 29. link to original article PubMed
AMC Rectal Pre Vs Post 2004: Park JH, Yoon SM, Yu CS, Kim JH, Kim TW, Kim JC. Randomized phase 3 trial comparing preoperative and postoperative chemoradiotherapy with capecitabine for locally advanced rectal cancer. Cancer. 2011 Aug 15;117(16):3703-12. Epub 2011 Feb 15. link to original article contains dosing details in abstract PubMed NCT01186081
Rektum-III: Hofheinz RD, Wenz F, Post S, Matzdorff A, Laechelt S, Hartmann JT, Müller L, Link H, Moehler M, Kettner E, Fritz E, Hieber U, Lindemann HW, Grunewald M, Kremers S, Constantin C, Hipp M, Hartung G, Gencer D, Kienle P, Burkholder I, Hochhaus A. Chemoradiotherapy with capecitabine versus fluorouracil for locally advanced rectal cancer: a randomised, multicentre, non-inferiority, phase 3 trial. Lancet Oncol. 2012 Jun;13(6):579-88. Epub 2012 Apr 12. link to original article contains dosing details in manuscript PubMed NCT01500993
NSABP R-04: O'Connell MJ, Colangelo LH, Beart RW, Petrelli NJ, Allegra CJ, Sharif S, Pitot HC, Shields AF, Landry JC, Ryan DP, Parda DS, Mohiuddin M, Arora A, Evans LS, Bahary N, Soori GS, Eakle J, Robertson JM, Moore DF Jr, Mullane MR, Marchello BT, Ward PJ, Wozniak TF, Roh MS, Yothers G, Wolmark N. 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. 2014 Jun 20;32(18):1927-34. Epub 2014 May 5. link to original article link to PMC article contains dosing details in manuscript PubMed NCT00058474
1. Update: Allegra CJ, Yothers G, O'Connell MJ, Beart RW, Wozniak TF, Pitot HC, Shields AF, Landry JC, Ryan DP, Arora A, Evans LS, Bahary N, Soori G, Eakle JF, Robertson JM, Moore DF Jr, Mullane MR, Marchello BT, Ward PJ, Sharif S, Roh MS, Wolmark N. Neoadjuvant 5-FU or capecitabine plus radiation with or without oxaliplatin in rectal cancer patients: a phase III randomized clinical trial. J Natl Cancer Inst. 2015 Sep 14;107(11). Erratum in: J Natl Cancer Inst. 2016 Apr;108(4). link to original article link to PMC article PubMed
INTERACT: Valentini V, Gambacorta MA, Cellini F, Aristei C, Coco C, Barbaro B, Alfieri S, D'Ugo D, Persiani R, Deodato F, Crucitti A, Lupattelli M, Mantello G, Navarria F, Belluco C, Buonadonna A, Boso C, Lonardi S, Caravatta L, Barba MC, Vecchio FM, Maranzano E, Genovesi D, Doglietto GB, Morganti AG, La Torre G, Pucciarelli S, De Paoli A. The INTERACT Trial: Long-term results of a randomised trial on preoperative capecitabine-based radiochemotherapy intensified by concomitant boost or oxaliplatin, for cT2 (distal)-cT3 rectal cancer. Radiother Oncol. 2019 May;134:110-118. Epub 2019 Feb 7. link to original article PubMed NCT01653301
CinClare: Zhu J, Liu A, Sun X, Liu L, Zhu Y, Zhang T, Jia J, Tan S, Wu J, Wang X, Zhou J, Yang J, Zhang C, Zhang H, Zhao Y, Cai G, Zhang W, Xia F, Wan J, Zhang H, Shen L, Cai S, Zhang Z. Multicenter, Randomized, Phase III Trial of Neoadjuvant Chemoradiation With Capecitabine and Irinotecan Guided by UGT1A1 Status in Patients With Locally Advanced Rectal Cancer. J Clin Oncol. 2020 Dec 20;38(36):4231-4239. Epub 2020 Oct 29. link to original article link to PMC article contains dosing details in manuscript PubMed NCT02605265
PETACC 6: Schmoll HJ, Stein A, Van Cutsem E, Price T, Hofheinz RD, Nordlinger B, Daisne JF, Janssens J, Brenner B, Reinel H, Hollerbach S, Caca K, Fauth F, Hannig CV, Zalcberg J, Tebbutt N, Mauer ME, Marreaud S, Lutz MP, Haustermans K. Pre- and Postoperative Capecitabine Without or With Oxaliplatin in Locally Advanced Rectal Cancer: PETACC 6 Trial by EORTC GITCG and ROG, AIO, AGITG, BGDO, and FFCD. J Clin Oncol. 2021 Jan 1;39(1):17-29. Epub 2020 Oct 1. link to original article contains dosing details in manuscript PubMed NCT00766155
UNICANCER-PRODIGE 23: Conroy T, Bosset JF, Etienne PL, Rio E, François É, Mesgouez-Nebout N, Vendrely V, Artignan X, Bouché O, Gargot D, Boige V, Bonichon-Lamichhane N, Louvet C, Morand C, de la Fouchardière C, Lamfichekh N, Juzyna B, Jouffroy-Zeller C, Rullier E, Marchal F, Gourgou S, Castan F, Borg C; Unicancer Gastrointestinal Group and Partenariat de Recherche en Oncologie Digestive (PRODIGE) Group. Neoadjuvant chemotherapy with FOLFIRINOX and preoperative chemoradiotherapy for patients with locally advanced rectal cancer (UNICANCER-PRODIGE 23): a multicentre, randomised, open-label, phase 3 trial. Lancet Oncol. 2021 May;22(5):702-715. Epub 2021 Apr 13. link to original article contains dosing details in abstract PubMed NCT01804790
STELLAR_rectal: Jin J, Tang Y, Hu C, Jiang LM, Jiang J, Li N, Liu WY, Chen SL, Li S, Lu NN, Cai Y, Li YH, Zhu Y, Cheng GH, Zhang HY, Wang X, Zhu SY, Wang J, Li GF, Yang JL, Zhang K, Chi Y, Yang L, Zhou HT, Zhou AP, Zou SM, Fang H, Wang SL, Zhang HZ, Wang XS, Wei LC, Wang WL, Liu SX, Gao YH, Li YX. Multicenter, Randomized, Phase III Trial of Short-Term Radiotherapy Plus Chemotherapy Versus Long-Term Chemoradiotherapy in Locally Advanced Rectal Cancer (STELLAR). J Clin Oncol. 2022 May 20;40(15):1681-1692. Epub 2022 Mar 9. link to original article link to PMC article NCT02533271 PubMed

Capecitabine, Sorafenib, RT

Capecitabine, Sorafenib, RT: Capecitabine, Sorafenib, Radiation Therapy

Regimen

Study	Evidence
von Moos et al. 2017 (SAKK 41/08)	Phase 1/2

Note: this regimen was intended for KRAS-mutated rectal cancer.

Chemotherapy

Capecitabine (Xeloda) 825 mg/m² PO twice per day on days 1 to 33

Targeted therapy

Sorafenib (Nexavar) 400 mg PO once per day

Radiotherapy

Concurrent radiation therapy, 45 Gy total

5-week course

Subsequent treatment

Surgery

References

SAKK 41/08: von Moos R, Koeberle D, Schacher S, Hayoz S, Winterhalder RC, Roth A, Bodoky G, Samaras P, Berger MD, Rauch D, Saletti P, Plasswilm L, Zwahlen D, Meier UR, Yan P, Izzo P, Klingbiel D, Bärtschi D, Zaugg K; Swiss Group for Clinical Cancer Research. Neoadjuvant radiotherapy combined with capecitabine and sorafenib in patients with advanced KRAS-mutated rectal cancer: A phase I/II trial (SAKK 41/08). Eur J Cancer. 2018 Jan;89:82-89. Epub 2017 Dec 11. link to original article PubMed

CapeOx

CapeOX: Capecitabine & OXaliplatin

Regimen variant #1, 4 cycles

Study	Years of enrollment	Evidence
Chua et al. 2010	2001-2005	Phase 2

Chemotherapy

Capecitabine (Xeloda) 1000 mg/m² PO twice per day on days 1 to 14
Oxaliplatin (Eloxatin) 130 mg/m² IV once on day 1

21-day cycle for 4 cycles

Subsequent treatment

Capecitabine & RT, then TME

Regimen variant #2, 6 cycles

Study	Years of enrollment	Evidence	Comparator	Comparative Efficacy
Bahadoer et al. 2020 (RAPIDO)	2011-2016	Phase 3 (E-switch-ic)	See link	See link

Preceding treatment

RT; 5 x 5 Gy

Chemotherapy

Capecitabine (Xeloda) 1000 mg/m² PO twice per day on days 1 to 14
Oxaliplatin (Eloxatin) 130 mg/m² IV once on day 1

21-day cycle for 6 cycles

Subsequent treatment

TME

References

Chua YJ, Barbachano Y, Cunningham D, Oates JR, Brown G, Wotherspoon A, Tait D, Massey A, Tebbutt NC, Chau I. Neoadjuvant capecitabine and oxaliplatin before chemoradiotherapy and total mesorectal excision in MRI-defined poor-risk rectal cancer: a phase 2 trial. Lancet Oncol. 2010 Mar;11(3):241-8. Epub 2010 Jan 25. link to original article contains dosing details in abstract PubMed NCT00220051
RAPIDO: Bahadoer RR, Dijkstra EA, van Etten B, Marijnen CAM, Putter H, Kranenbarg EM, Roodvoets AGH, Nagtegaal ID, Beets-Tan RGH, Blomqvist LK, Fokstuen T, Ten Tije AJ, Capdevila J, Hendriks MP, Edhemovic I, Cervantes A, Nilsson PJ, Glimelius B, van de Velde CJH, Hospers GAP; RAPIDO collaborative investigators. Short-course radiotherapy followed by chemotherapy before total mesorectal excision (TME) versus preoperative chemoradiotherapy, TME, and optional adjuvant chemotherapy in locally advanced rectal cancer (RAPIDO): a randomised, open-label, phase 3 trial. Lancet Oncol. 2021 Jan;22(1):29-42. Epub 2020 Dec 7. link to original article contains dosing details in manuscript PubMed NCT01558921

CapeOx, Cetuximab, RT

CapeOX, Cetuximab, RT: Capecitabine, OXaliplatin, Cetuximab, Radiation Therapy

Regimen

Study	Evidence
Leichman et al. 2017 (SWOG S0713)	Phase 2

Chemotherapy

Capecitabine (Xeloda) 825 mg/m² PO twice per day on Monday to Friday
Oxaliplatin (Eloxatin) as follows:
- Cycle 1: 50 mg/m² IV once per day on days 1, 8, 15, 22, 29
- Cycle 2: 50 mg/m² IV once per day on days 1, 8, 22, 29

Targeted therapy

Cetuximab (Erbitux) as follows:
- Cycle 1: 400 mg/m² IV once on day 1, then 250 mg/m² IV once per day on days 8, 15, 22, 29
- Cycle 2: 250 mg/m² IV once per day on days 1, 8, 15, 22, 29

35-day cycle for 2 cycles

Radiotherapy

RT 180 cGy in 25 fractions, started with cycle 2

5-week course

Subsequent treatment

TME

References

SWOG S0713: Leichman CG, McDonough SL, Smalley SR, Billingsley KG, Lenz HJ, Beldner MA, Hezel AF, Velasco MR, Guthrie KA, Blanke CD, Hochster HS. Cetuximab Combined With Induction Oxaliplatin and Capecitabine, Followed by Neoadjuvant Chemoradiation for Locally Advanced Rectal Cancer: SWOG 0713. Clin Colorectal Cancer. 2018 Mar;17(1):e121-e125. Epub 2017 Oct 24. link to original article contains dosing details in manuscript PubMed

CapIriRT

CapIriRT: Capecitabine, Irinotecan, Radiation Therapy

Regimen variant #1, 65 mg/m²

Study	Years of enrollment	Evidence	Comparator	Comparative Efficacy
Zhu et al. 2020 (CinClare)	2015-2017	Phase 3 (C)	See link	See link

Note: Treatment is assumed to start on a Monday. Surgery is to take place 8 weeks after completion of chemoradiotherapy.

Biomarker eligibility criteria

UGT1A1*1*28 genotype

Chemotherapy

Capecitabine (Xeloda) 625 mg/m² PO twice per day on days 1 to 5
Irinotecan (Camptosar) 65 mg/m² IV once on day 1

7-day cycle for 5 cycles

Radiotherapy

Concurrent radiation therapy, 50 Gy total in 25 fractions

5-week course

Subsequent treatment

CAPIRI x 1, then TME, then CapeOx x 5

Regimen variant #2, 80 mg/m²

Study	Years of enrollment	Evidence	Comparator	Comparative Efficacy
Zhu et al. 2020 (CinClare)	2015-2017	Phase 3 (C)	See link	See link

Note: Treatment is assumed to start on a Monday. Surgery is to take place 8 weeks after completion of chemoradiotherapy.

Biomarker eligibility criteria

UGT1A1*1*1 genotype

Chemotherapy

Capecitabine (Xeloda) 625 mg/m² PO twice per day on days 1 to 5
Irinotecan (Camptosar) 80 mg/m² IV once on day 1

7-day cycle for 5 cycles

Radiotherapy

Concurrent radiation therapy, 50 Gy total in 25 fractions

5-week course

Subsequent treatment

CAPIRI x 1, then TME, then CapeOx x 5

References

CinClare: Zhu J, Liu A, Sun X, Liu L, Zhu Y, Zhang T, Jia J, Tan S, Wu J, Wang X, Zhou J, Yang J, Zhang C, Zhang H, Zhao Y, Cai G, Zhang W, Xia F, Wan J, Zhang H, Shen L, Cai S, Zhang Z. Multicenter, Randomized, Phase III Trial of Neoadjuvant Chemoradiation With Capecitabine and Irinotecan Guided by UGT1A1 Status in Patients With Locally Advanced Rectal Cancer. J Clin Oncol. 2020 Dec 20;38(36):4231-4239. Epub 2020 Oct 29. link to original article link to PMC article contains dosing details in manuscript PubMed NCT02605265

Fluorouracil & RT

Fluorouracil & RT: Fluorouracil & Radiation Therapy

Regimen variant #1, continuous

Study	Years of enrollment	Evidence	Comparator	Comparative Efficacy	Comparative Toxicity
Ngan et al. 2012 (TROG 01.014)	2001-2006	Phase 3 (C)	Short-course RT	Did not meet primary endpoint of LR rate at 36 mo	Similar toxicity
Aschele et al. 2011 (STAR-01)	2003-2008	Phase 3 (C)	FUOX & RT	Did not meet primary endpoint of OS¹	Less toxic
O'Connell et al. 2014 (NSABP R-04)	2004-2010	Phase 3 (C)	1. Capecitabine & RT	Did not meet primary endpoint of LRC	Similar toxicity
O'Connell et al. 2014 (NSABP R-04)	2004-2010	Phase 3 (C)	2. CapeOx & RT 3. FUOX & RT	Did not meet primary endpoint of LRC	Superior toxicity

¹Reported efficacy for STAR-01 is based on the 2016 update.

Chemotherapy

Fluorouracil (5-FU) 225 mg/m²/day IV continuous infusion until the end of radiation, started on day 1

Radiotherapy

Concurrent radiation therapy, 1.8 Gy for 25 fractions (45 Gy), with boost depending on stage

5-week course

Subsequent treatment

STAR-01: Surgery, preferably TME, then adjuvant fluourouracil-based therapy
NSABP R-04: Surgery

Regimen variant #2, intermittent

Study	Years of enrollment	Evidence	Comparator	Comparative Efficacy
Sauer et al. 2004 (CAO/ARO/AIO-94)	1995-2002	Phase 3 (E-switch-ic)	5-FU & RT; adjuvant	Superior five-year cumulative incidence of local relapse
Hofheinz et al. 2012 (Rektum-III)	2002-2007	Phase 3 (C)	Capecitabine & RT	Non-inferior OS
Rödel et al. 2012 (CAO/ARO/AIO-04)	2006-2010	Phase 3 (C)	FUOX & RT	Seems to have inferior pCR rate

Chemotherapy

Fluorouracil (5-FU) 1000 mg/m²/day IV continuous infusion over 120 hours, started on day 1 (total dose per cycle: 5000 mg/m²)

28-day cycle for 2 cycles

Radiotherapy

Concurrent radiation therapy, 50.4 Gy total

One course

Subsequent treatment

CAO/ARO/AIO-94: TME, then adjuvant 5-FU

References

CAO/ARO/AIO-94: Sauer R, Becker H, Hohenberger W, Rödel C, Wittekind C, Fietkau R, Martus P, Tschmelitsch J, Hager E, Hess CF, Karstens JH, Liersch T, Schmidberger H, Raab R; German Rectal Cancer Study Group. Preoperative versus postoperative chemoradiotherapy for rectal cancer. N Engl J Med. 2004 Oct 21;351(17):1731-40. link to original article contains dosing details in manuscript PubMed
1. Update: Sauer R, Liersch T, Merkel S, Fietkau R, Hohenberger W, Hess C, Becker H, Raab HR, Villanueva MT, Witzigmann H, Wittekind C, Beissbarth T, Rödel C. Preoperative versus postoperative chemoradiotherapy for locally advanced rectal cancer: results of the German CAO/ARO/AIO-94 randomized phase III trial after a median follow-up of 11 years. J Clin Oncol. 2012 Jun 1;30(16):1926-33. Epub 2012 Apr 23. link to original article PubMed
STAR-01: Aschele C, Cionini L, Lonardi S, Pinto C, Cordio S, Rosati G, Artale S, Tagliagambe A, Ambrosini G, Rosetti P, Bonetti A, Negru ME, Tronconi MC, Luppi G, Silvano G, Corsi DC, Bochicchio AM, Chiaulon G, Gallo M, Boni L. 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. 2011 Jul 10;29(20):2773-80. Epub 2011 May 23. link to original article contains dosing details in manuscript PubMed
1. Update: Abstract: Carlo Aschele, Sara Lonardi, Luca Cionini, Carmine Pinto, Stefano Sergio Cordio, Gerardo Rosati, Andrea Sartore Bianchi, Angiolo Tagliagambe, Michela Frisinghelli, Vittorina Zagonel, Paola Rosetti, Maria Emanuela Negru, Andrea Bonetti, Maria Chiara Tronconi, Gabriele Luppi, Anna Rita Marsella, Domenico C. Corsi, Anna Maria Bochicchio, Nicoletta Pella, and Luca Boni. Final results of STAR-01: A randomized phase III trial comparing preoperative chemoradiation with or without oxaliplatin in locally advanced rectal cancer. Journal of Clinical Oncology 2016 34:15_suppl, 3521-3521 link to abstract
Rektum-III: Hofheinz RD, Wenz F, Post S, Matzdorff A, Laechelt S, Hartmann JT, Müller L, Link H, Moehler M, Kettner E, Fritz E, Hieber U, Lindemann HW, Grunewald M, Kremers S, Constantin C, Hipp M, Hartung G, Gencer D, Kienle P, Burkholder I, Hochhaus A. Chemoradiotherapy with capecitabine versus fluorouracil for locally advanced rectal cancer: a randomised, multicentre, non-inferiority, phase 3 trial. Lancet Oncol. 2012 Jun;13(6):579-88. Epub 2012 Apr 12. link to original article contains dosing details in manuscript PubMed NCT01500993
CAO/ARO/AIO-04: Rödel C, Liersch T, Becker H, Fietkau R, Hohenberger W, Hothorn T, Graeven U, Arnold D, Lang-Welzenbach M, Raab HR, Sülberg H, Wittekind C, Potapov S, Staib L, Hess C, Weigang-Köhler K, Grabenbauer GG, Hoffmanns H, Lindemann F, Schlenska-Lange A, Folprecht G, Sauer R; 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. 2012 Jul;13(7):679-87. Epub 2012 May 23. link to original article contains dosing details in abstract PubMed NCT00349076
1. Update: Rödel C, Graeven U, Fietkau R, Hohenberger W, Hothorn T, Arnold D, Hofheinz RD, Ghadimi M, Wolff HA, Lang-Welzenbach M, Raab HR, Wittekind C, Ströbel P, Staib L, Wilhelm M, Grabenbauer GG, Hoffmanns H, Lindemann F, Schlenska-Lange A, Folprecht G, Sauer R, Liersch T; German Rectal Cancer Study Group. Oxaliplatin added to fluorouracil-based preoperative chemoradiotherapy and postoperative chemotherapy of locally advanced rectal cancer (the German CAO/ARO/AIO-04 study): final results of the multicentre, open-label, randomised, phase 3 trial. Lancet Oncol. 2015 Aug;16(8):979-89. Epub 2015 Jul 15. link to original article PubMed
TROG 01.014: Ngan SY, Burmeister B, Fisher RJ, Solomon M, Goldstein D, Joseph D, Ackland SP, Schache D, McClure B, McLachlan SA, McKendrick J, Leong T, Hartopeanu C, Zalcberg J, Mackay J. Randomized trial of short-course radiotherapy versus long-course chemoradiation comparing rates of local recurrence in patients with T3 rectal cancer: Trans-Tasman Radiation Oncology Group trial 01.04. J Clin Oncol. 2012 Nov 1;30(31):3827-33. Epub 2012 Sep 24. Erratum in: J Clin Oncol. 2013 Jan 20;31(3):399. link to original article PubMed NCT00351598
NSABP R-04: O'Connell MJ, Colangelo LH, Beart RW, Petrelli NJ, Allegra CJ, Sharif S, Pitot HC, Shields AF, Landry JC, Ryan DP, Parda DS, Mohiuddin M, Arora A, Evans LS, Bahary N, Soori GS, Eakle J, Robertson JM, Moore DF Jr, Mullane MR, Marchello BT, Ward PJ, Wozniak TF, Roh MS, Yothers G, Wolmark N. 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. 2014 Jun 20;32(18):1927-34. Epub 2014 May 5. link to original article link to PMC article contains dosing details in manuscript PubMed NCT00058474
1. Update: Allegra CJ, Yothers G, O'Connell MJ, Beart RW, Wozniak TF, Pitot HC, Shields AF, Landry JC, Ryan DP, Arora A, Evans LS, Bahary N, Soori G, Eakle JF, Robertson JM, Moore DF Jr, Mullane MR, Marchello BT, Ward PJ, Sharif S, Roh MS, Wolmark N. Neoadjuvant 5-FU or capecitabine plus radiation with or without oxaliplatin in rectal cancer patients: a phase III randomized clinical trial. J Natl Cancer Inst. 2015 Sep 14;107(11). Erratum in: J Natl Cancer Inst. 2016 Apr;108(4). link to original article link to PMC article PubMed

FOLFIRINOX

FOLFIRINOX: FOLinic acid, Fluorouracil, IRINotecan, OXaliplatin

Regimen

Study	Years of enrollment	Evidence	Comparator	Comparative Efficacy
Conroy et al. 2021 (UNICANCER-PRODIGE 23)	2012-2017	Phase 3 (E-esc)	No neoadjuvant chemotherapy	Seems to have superior DFS DFS36: 76% vs 69% (sHR 0.69, 95% CI 0.49-0.97)

Chemotherapy

Folinic acid (Leucovorin) 400 mg/m² IV once on day 1
Fluorouracil (5-FU) 2400 mg/m² IV continuous infusion (duration not specified)
Irinotecan (Camptosar) 180 mg/m² IV once on day 1
Oxaliplatin (Eloxatin) 85 mg/m² IV once on day 1

14-day cycle for 6 cycles

Subsequent treatment

Capecitabine & RT

References

UNICANCER-PRODIGE 23: Conroy T, Bosset JF, Etienne PL, Rio E, François É, Mesgouez-Nebout N, Vendrely V, Artignan X, Bouché O, Gargot D, Boige V, Bonichon-Lamichhane N, Louvet C, Morand C, de la Fouchardière C, Lamfichekh N, Juzyna B, Jouffroy-Zeller C, Rullier E, Marchal F, Gourgou S, Castan F, Borg C; Unicancer Gastrointestinal Group and Partenariat de Recherche en Oncologie Digestive (PRODIGE) Group. Neoadjuvant chemotherapy with FOLFIRINOX and preoperative chemoradiotherapy for patients with locally advanced rectal cancer (UNICANCER-PRODIGE 23): a multicentre, randomised, open-label, phase 3 trial. Lancet Oncol. 2021 May;22(5):702-715. Epub 2021 Apr 13. link to original article contains dosing details in abstract PubMed NCT01804790

FULV & RT

FULV & RT: FluoroUracil, LeucoVorin (Folinic acid) & Radiation Therapy

Regimen variant #1, 800/200 ("Nordic schedule")

Study	Years of enrollment	Evidence	Comparator	Comparative Efficacy
Braendengen et al. 2008 (LARCS)	1996-2003	Phase 3 (E-esc)	Radiotherapy	Might have superior OS60

Note: reported efficacy is based on the 2018 update.

Chemotherapy

Fluorouracil (5-FU) 400 mg/m² IV once per day on days 1 & 2, given first, prior to RT
Folinic acid (Leucovorin) 100 mg IV once per day on days 1 & 2, given second

14-day cycle for 3 cycles

Radiotherapy

Concurrent radiation therapy, 2 Gy x 25 fractions (total of 50 Gy)

5-week course

Subsequent treatment

Surgery, then FULV x 8

Regimen variant #2, 1625/100

Study	Years of enrollment	Evidence	Comparator	Comparative Efficacy
Roh et al. 2009 (NSABP R-03)	1993-1999	Phase 3 (E-esc)	Postoperative 5-FU/5-FU & RT	Might have superior OS

Preceding treatment

FULV x 1

Chemotherapy

Fluorouracil (5-FU) 325 mg/m² IV once per day on days 1 to 5
Folinic acid (Leucovorin) 20 mg/m² IV once per day on days 1 to 5

28-day cycle for 2 cycles

Radiotherapy

Concurrent radiation therapy, 50.4 Gy

5-week course

Subsequent treatment

Surgery, then FULV x 4

Regimen variant #3, 1750/100

Study	Years of enrollment	Evidence	Comparator	Comparative Efficacy
Sainato et al. 2014 (I-CNR-RT)	1992-2001	Non-randomized portion of RCT
Bosset et al. 2006 (EORTC 22921)	1993-2003	Phase 3 (E-esc)	Radiotherapy	Did not meet primary endpoint of OS¹
Gérard et al. 2006 (FFCD 9203)	1993-2003	Phase 3 (E-esc)	Radiotherapy	Did not meet primary endpoint of OS¹

¹These trials were negative for the primary endpoint of overall survival, but had much improved local control for the experimental arm.

Chemotherapy

Fluorouracil (5-FU) 350 mg/m² IV once per day on days 1 to 5
Folinic acid (Leucovorin) 20 mg/m² IV once per day on days 1 to 5

28-day cycle for 2 cycles

Radiotherapy

Concurrent radiation therapy, 45 Gy

5-week course

Subsequent treatment

FFCD 9203 & EORTC 22921: Surgery, then adjuvant FULV x 2
I-CNR-RT: Surgery, then adjuvant FULV versus no further treatment

Regimen variant #4, 2800/400

Study	Years of enrollment	Evidence	Comparator	Comparative Efficacy
Deng et al. 2016 (FOWARC)	2010-2015	Phase 3 (C)	1. mFOLFOX6	Did not meet primary endpoint of DFS36¹
Deng et al. 2016 (FOWARC)	2010-2015	Phase 3 (C)	2. mFOLFOX6 & RT	Did not meet primary endpoint of DFS36¹

¹Reported efficacy is based on the 2019 update.
Note: this regimen is stated to be based on the de Gramont regimen in the manuscript, although the details are different than those in de Gramont et al. 2000.

Chemotherapy

Fluorouracil (5-FU) 400 mg/m² IV bolus once on day 1, then 1200 mg/m²/day IV continuous infusion over 48 hours (total dose per cycle: 2800 mg/m²)
Folinic acid (Leucovorin) 400 mg/m² IV once on day 1

14-day cycle for 5 cycles

Radiotherapy

Concurrent radiation therapy given during cycles 2 to 4: 1.8 to 2 Gy once per day Monday through Friday for a total of 23 to 28 fractions over 5 to 6 weeks and a total dose of 46 to 50.4 Gy

6-week course

Subsequent treatment

Surgery, then adjuvant FULV x 7

References

FFCD 9203: Gérard JP, Conroy T, Bonnetain F, Bouché O, Chapet O, Closon-Dejardin MT, Untereiner M, Leduc B, Francois E, Maurel J, Seitz JF, Buecher B, Mackiewicz R, Ducreux M, Bedenne L. Preoperative radiotherapy with or without concurrent fluorouracil and leucovorin in T3-4 rectal cancers: results of FFCD 9203. J Clin Oncol. 2006 Oct 1;24(28):4620-5. link to original article contains dosing details in manuscript PubMed NCT00296608
EORTC 22921: Bosset JF, Collette L, Calais G, Mineur L, Maingon P, Radosevic-Jelic L, Daban A, Bardet E, Beny A, Ollier JC; EORTC Radiotherapy Group. Chemotherapy with preoperative radiotherapy in rectal cancer. N Engl J Med. 2006 Sep 14;355(11):1114-23. Erratum in: N Engl J Med. 2007 Aug 16;357(7):728. link to original article contains dosing details in manuscript PubMed NCT00002523
1. Update: Bosset JF, Calais G, Mineur L, Maingon P, Stojanovic-Rundic S, Bensadoun RJ, Bardet E, Beny A, Ollier JC, Bolla M, Marchal D, Van Laethem JL, Klein V, Giralt J, Clavère P, Glanzmann C, Cellier P, Collette L; EORTC Radiation Oncology Group. Fluorouracil-based adjuvant chemotherapy after preoperative chemoradiotherapy in rectal cancer: long-term results of the EORTC 22921 randomised study. Lancet Oncol. 2014 Feb;15(2):184-90. Epub 2014 Jan 17. link to original article PubMed
LARCS: Braendengen M, Tveit KM, Berglund A, Birkemeyer E, Frykholm G, Påhlman L, Wiig JN, Byström P, Bujko K, Glimelius B. Randomized phase III study comparing preoperative radiotherapy with chemoradiotherapy in nonresectable rectal cancer. J Clin Oncol. 2008 Aug 1;26(22):3687-94. link to original article PubMed
1. Update: Brændengen M, Glimelius B. Preoperative radiotherapy or chemoradiotherapy in rectal cancer - Is survival improved? An update of the "Nordic" LARC study in non-resectable cancers. Radiother Oncol. 2018 Jun;127(3):392-395. Epub 2018 May 16. link to original article PubMed
NSABP R-03: Roh MS, Colangelo LH, O'Connell MJ, Yothers G, Deutsch M, Allegra CJ, Kahlenberg MS, Baez-Diaz L, Ursiny CS, Petrelli NJ, Wolmark N. Preoperative multimodality therapy improves disease-free survival in patients with carcinoma of the rectum: NSABP R-03. J Clin Oncol. 2009 Nov 1;27(31):5124-30. Epub 2009 Sep 21. link to original article link to PMC article contains dosing details in manuscript PubMed
I-CNR-RT: Sainato A, Cernusco Luna Nunzia V, Valentini V, De Paoli A, Maurizi ER, Lupattelli M, Aristei C, Vidali C, Conti M, Galardi A, Ponticelli P, Friso ML, Iannone T, Osti FM, Manfredi B, Coppola M, Orlandini C, Cionini L. No benefit of adjuvant Fluorouracil Leucovorin chemotherapy after neoadjuvant chemoradiotherapy in locally advanced cancer of the rectum (LARC): Long term results of a randomized trial (I-CNR-RT). Radiother Oncol. 2014 Nov;113(2):223-9. Epub 2014 Nov 14. link to original article contains dosing details in abstract PubMed
FOWARC: Deng Y, Chi P, Lan P, Wang L, Chen W, Cui L, Chen D, Cao J, Wei H, Peng X, Huang Z, Cai G, Zhao R, Huang Z, Xu L, Zhou H, Wei Y, Zhang H, Zheng J, Huang Y, Zhou Z, Cai Y, Kang L, Huang M, Peng J, Ren D, Wang J. Modified FOLFOX6 with or without radiation versus fluorouracil and leucovorin with radiation in neoadjuvant treatment of locally advanced rectal cancer: initial results of the Chinese FOWARC multicenter, open-label, randomized three-arm phase III trial. J Clin Oncol. 2016 Sep 20;34(27):3300-7. Epub 2016 Aug 1. link to original article contains dosing details in manuscript PubMed NCT01211210
1. Update: Deng Y, Chi P, Lan P, Wang L, Chen W, Cui L, Chen D, Cao J, Wei H, Peng X, Huang Z, Cai G, Zhao R, Huang Z, Xu L, Zhou H, Wei Y, Zhang H, Zheng J, Huang Y, Zhou Z, Cai Y, Kang L, Huang M, Wu X, Peng J, Ren D, Wang J. Neoadjuvant Modified FOLFOX6 With or Without Radiation Versus Fluorouracil Plus Radiation for Locally Advanced Rectal Cancer: Final Results of the Chinese FOWARC Trial. J Clin Oncol. 2019 Dec 1;37(34):3223-3233. Epub 2019 Sep 26. link to original article PubMed

FUOX & RT

FUOX & RT: FluoroUracil, OXaliplatin, Radiation Therapy

Regimen variant #1, 225/50

Study	Years of enrollment	Evidence	Comparator	Comparative Efficacy	Comparative Toxicity
O'Connell et al. 2014 (NSABP R-04)	2004-2010	Phase 3 (E-esc)	1. 5-FU & RT 2. Capecitabine & RT	Did not meet primary endpoint of LRC	Inferior toxicity
O'Connell et al. 2014 (NSABP R-04)	2004-2010	Phase 3 (E-esc)	3. CapeOx & RT	Did not meet primary endpoint of LRC	Similar toxicity

Note: this is an experimental arm that did not meet its primary endpoint; included here because other variants of this regimen have demonstrated comparative superiority.

Chemotherapy

Fluorouracil (5-FU) 225 mg/m²/day IV continuous infusion over 120 hours, started on day 1 (total dose per cycle: 1125 mg/m²)
Oxaliplatin (Eloxatin) 50 mg/m² IV once on day 1

7-day cycle for 5 cycles

Radiotherapy

Concurrent radiation therapy, 50.4 Gy total

5.5-week course

Subsequent treatment

Surgery

Regimen variant #2, 225/60

Study	Years of enrollment	Evidence	Comparator	Comparative Efficacy	Comparative Toxicity
Aschele et al. 2011 (STAR-01)	2003-2008	Phase 3 (E-esc)	Fluorouracil & RT	Did not meet primary endpoint of OS¹	More toxic

¹Reported efficacy is based on the 2016 update.
Note: This is an experimental arm that did not meet its primary endpoint; included here because other variants of this regimen have demonstrated comparative superiority.

Chemotherapy

Fluorouracil (5-FU) 225 mg/m²/day IV continuous infusion over approximately 6 weeks, started on day 1
Oxaliplatin (Eloxatin) 60 mg/m² IV once per day on days 1, 8, 15, 22, 29, 36

Radiotherapy

Concurrent radiation therapy, 50.4 Gy total

6-week course

Subsequent treatment

Surgery, preferably TME, then adjuvant fluourouracil-based therapy

Regimen variant #3, 250/50

Study	Years of enrollment	Evidence	Comparator	Comparative Efficacy
Rödel et al. 2012 (CAO/ARO/AIO-04)	2006-2010	Phase 3 (E-esc)	Fluorouracil & RT	Seems to have superior pCR rate

Chemotherapy

Fluorouracil (5-FU) 250 mg/m²/day IV continuous infusion over 14 days, started on day 1 (total dose per cycle: 3500 mg/m²)
Oxaliplatin (Eloxatin) 50 mg/m² IV once per day on days 1 & 8

21-day cycle for 2 cycles

Radiotherapy

Concurrent radiation therapy, 50.4 Gy total

One course

Subsequent treatment

Surgery, then adjuvant FOLFOX

References

STAR-01: Aschele C, Cionini L, Lonardi S, Pinto C, Cordio S, Rosati G, Artale S, Tagliagambe A, Ambrosini G, Rosetti P, Bonetti A, Negru ME, Tronconi MC, Luppi G, Silvano G, Corsi DC, Bochicchio AM, Chiaulon G, Gallo M, Boni L. 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. 2011 Jul 10;29(20):2773-80. Epub 2011 May 23. link to original article contains dosing details in manuscript PubMed
1. Update: Abstract: Carlo Aschele, Sara Lonardi, Luca Cionini, Carmine Pinto, Stefano Sergio Cordio, Gerardo Rosati, Andrea Sartore Bianchi, Angiolo Tagliagambe, Michela Frisinghelli, Vittorina Zagonel, Paola Rosetti, Maria Emanuela Negru, Andrea Bonetti, Maria Chiara Tronconi, Gabriele Luppi, Anna Rita Marsella, Domenico C. Corsi, Anna Maria Bochicchio, Nicoletta Pella, and Luca Boni. Final results of STAR-01: A randomized phase III trial comparing preoperative chemoradiation with or without oxaliplatin in locally advanced rectal cancer. Journal of Clinical Oncology 2016 34:15_suppl, 3521-3521 link to abstract
CAO/ARO/AIO-04: Rödel C, Liersch T, Becker H, Fietkau R, Hohenberger W, Hothorn T, Graeven U, Arnold D, Lang-Welzenbach M, Raab HR, Sülberg H, Wittekind C, Potapov S, Staib L, Hess C, Weigang-Köhler K, Grabenbauer GG, Hoffmanns H, Lindemann F, Schlenska-Lange A, Folprecht G, Sauer R; 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. 2012 Jul;13(7):679-87. Epub 2012 May 23. link to original article contains dosing details in abstract PubMed NCT00349076
1. Update: Rödel C, Graeven U, Fietkau R, Hohenberger W, Hothorn T, Arnold D, Hofheinz RD, Ghadimi M, Wolff HA, Lang-Welzenbach M, Raab HR, Wittekind C, Ströbel P, Staib L, Wilhelm M, Grabenbauer GG, Hoffmanns H, Lindemann F, Schlenska-Lange A, Folprecht G, Sauer R, Liersch T; German Rectal Cancer Study Group. Oxaliplatin added to fluorouracil-based preoperative chemoradiotherapy and postoperative chemotherapy of locally advanced rectal cancer (the German CAO/ARO/AIO-04 study): final results of the multicentre, open-label, randomised, phase 3 trial. Lancet Oncol. 2015 Aug;16(8):979-89. Epub 2015 Jul 15. link to original article PubMed
NSABP R-04: O'Connell MJ, Colangelo LH, Beart RW, Petrelli NJ, Allegra CJ, Sharif S, Pitot HC, Shields AF, Landry JC, Ryan DP, Parda DS, Mohiuddin M, Arora A, Evans LS, Bahary N, Soori GS, Eakle J, Robertson JM, Moore DF Jr, Mullane MR, Marchello BT, Ward PJ, Wozniak TF, Roh MS, Yothers G, Wolmark N. 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. 2014 Jun 20;32(18):1927-34. Epub 2014 May 5. link to original article link to PMC article contains dosing details in manuscript PubMed NCT00058474
1. Update: Allegra CJ, Yothers G, O'Connell MJ, Beart RW, Wozniak TF, Pitot HC, Shields AF, Landry JC, Ryan DP, Arora A, Evans LS, Bahary N, Soori G, Eakle JF, Robertson JM, Moore DF Jr, Mullane MR, Marchello BT, Ward PJ, Sharif S, Roh MS, Wolmark N. Neoadjuvant 5-FU or capecitabine plus radiation with or without oxaliplatin in rectal cancer patients: a phase III randomized clinical trial. J Natl Cancer Inst. 2015 Sep 14;107(11). Erratum in: J Natl Cancer Inst. 2016 Apr;108(4). link to original article link to PMC article PubMed

mFOLFOX6 & RT

mFOLFOX6 & RT: modified FOLinic acid, Fluorouracil, OXaliplatin and Radiation Therapy

Regimen

Study	Years of enrollment	Evidence	Comparator	Comparative Efficacy
Deng et al. 2016 (FOWARC)	2010-2015	Phase 3 (E-esc)	1. FULV & RT	Did not meet primary endpoint of DFS36¹
Deng et al. 2016 (FOWARC)	2010-2015	Phase 3 (E-esc)	2. mFOLFOX6	Did not meet primary endpoint of DFS36¹

¹Reported efficacy is based on the 2019 update.

Chemotherapy

Folinic acid (Leucovorin) 400 mg/m² IV once on day 1
Fluorouracil (5-FU) 400 mg/m² IV bolus once on day 1, then 1200 mg/m²/day IV continuous infusion over 48 hours (total dose per cycle: 2800 mg/m²)
Oxaliplatin (Eloxatin) 85 mg/m² IV once on day 1

14-day cycle for 4 to 6 cycles

Radiotherapy

Concurrent radiation therapy given before or after surgery at physician discretion: 1.8 to 2 Gy once per day Monday through Friday for a total of 23 to 28 fractions, for a total dose of 46 to 50.4 Gy

5- to 6-week course

Subsequent treatment

Surgery, then 6 to 8 more cycles of mFOLFOX6

References

FOWARC: Deng Y, Chi P, Lan P, Wang L, Chen W, Cui L, Chen D, Cao J, Wei H, Peng X, Huang Z, Cai G, Zhao R, Huang Z, Xu L, Zhou H, Wei Y, Zhang H, Zheng J, Huang Y, Zhou Z, Cai Y, Kang L, Huang M, Peng J, Ren D, Wang J. Modified FOLFOX6 with or without radiation versus fluorouracil and leucovorin with radiation in neoadjuvant treatment of locally advanced rectal cancer: initial results of the Chinese FOWARC multicenter, open-label, randomized three-arm phase III trial. J Clin Oncol. 2016 Sep 20;34(27):3300-7. Epub 2016 Aug 1. link to original article contains dosing details in manuscript PubMed NCT01211210
1. Update: Deng Y, Chi P, Lan P, Wang L, Chen W, Cui L, Chen D, Cao J, Wei H, Peng X, Huang Z, Cai G, Zhao R, Huang Z, Xu L, Zhou H, Wei Y, Zhang H, Zheng J, Huang Y, Zhou Z, Cai Y, Kang L, Huang M, Wu X, Peng J, Ren D, Wang J. Neoadjuvant Modified FOLFOX6 With or Without Radiation Versus Fluorouracil Plus Radiation for Locally Advanced Rectal Cancer: Final Results of the Chinese FOWARC Trial. J Clin Oncol. 2019 Dec 1;37(34):3223-3233. Epub 2019 Sep 26. link to original article PubMed

Radiation therapy

RT: Radiation Therapy

Regimen variant #1, 25 Gy

Study	Years of enrollment	Evidence	Comparator	Comparative Efficacy
Cedermark et al. 1997 (Swedish Rectal Cancer Trial)	1987-1990	Phase 3 (E-esc)	Surgery alone	Superior OS
Kapiteijn et al. 2001	1996-1999	Phase 3 (E-esc)	Surgery alone	Superior local recurrence rate
Sebag-Montefiore et al. 2009 (MRC CR07; NCIC-CTG CO.16)	1998-2005	Phase 3 (C)	Selective postoperative 5-FU & RT	Seems to have superior DFS
Bujko et al. 2016 (Polish II)	2008-2014	Phase 3 (E-switch-ic)	FULV & RT	Might have superior R0 resection rate
Bahadoer et al. 2020 (RAPIDO)	2011-2016	Phase 3 (E-switch-ic)	See link	See link

Radiotherapy

Radiation therapy, 5 Gy once per day for a total of 5 fractions (total dose: 25 Gy)

5-day course

Subsequent treatment

Swedish Rectal Cancer Trial, Kapiteijn et al. 2001, NCIC-CTG CO.16: Surgery
Polish II: FOLFOX4 x 3, then Surgery
RAPIDO: CapeOx x 6 or FOLFOX4 x 9, then Surgery

Regimen variant #2, 40 Gy

Study	Years of enrollment	Evidence	Comparator	Comparative Efficacy
Oates et al. 1996	1981-1989	Phase 3 (E-esc)	Surgery alone	Seems to have superior DFS

Note: This variant is of historic interest.

Radiotherapy

Radiation therapy, 2 Gy x 20 fractions (total dose: 40 Gy)

4-week course

Subsequent treatment

Surgery

Regimen variant #3, 50 Gy

Study	Years of enrollment	Evidence	Comparator	Comparative Efficacy
Braendengen et al. 2008 (LARCS)	1996-2003	Phase 3 (C)	FULV & RT	Might have inferior OS60

Note: this variant is of historic interest.

Radiotherapy

Radiation therapy, 2 Gy x 25 fractions (total dose: 50 Gy)

5-week course

Subsequent treatment

Surgery

References

Oates GD, Stenning SP, Hardcastle JD; Medical Research Council Rectal Cancer Working Party. Randomised trial of surgery alone versus radiotherapy followed by surgery for potentially operable locally advanced rectal cancer. Lancet. 1996 Dec 14;348(9042):1605-10. link to original article contains dosing details in abstract PubMed
Swedish Rectal Cancer Trial: Cedermark B, Dahlberg M, Glimelius B, Påhlman L, Rutqvist LE, Wilking N; Swedish Rectal Cancer Trial investigators. Improved survival with preoperative radiotherapy in resectable rectal cancer. N Engl J Med. 1997 Apr 3;336(14):980-7. Erratum in: N Engl J Med 1997 May 22;336(21):1539. link to original article PubMed
1. Update: Folkesson J, Birgisson H, Pahlman L, Cedermark B, Glimelius B, Gunnarsson U. Swedish Rectal Cancer Trial: long lasting benefits from radiotherapy on survival and local recurrence rate. J Clin Oncol. 2005 Aug 20;23(24):5644-50. link to original article PubMed
Kapiteijn E, Marijnen CA, Nagtegaal ID, Putter H, Steup WH, Wiggers T, Rutten HJ, Pahlman L, Glimelius B, van Krieken JH, Leer JW, van de Velde CJ; Dutch Colorectal Cancer Group. Preoperative radiotherapy combined with total mesorectal excision for resectable rectal cancer. N Engl J Med. 2001 Aug 30;345(9):638-46. link to original article PubMed
LARCS: Braendengen M, Tveit KM, Berglund A, Birkemeyer E, Frykholm G, Påhlman L, Wiig JN, Byström P, Bujko K, Glimelius B. Randomized phase III study comparing preoperative radiotherapy with chemoradiotherapy in nonresectable rectal cancer. J Clin Oncol. 2008 Aug 1;26(22):3687-94. link to original article PubMed
1. Update: Brændengen M, Glimelius B. Preoperative radiotherapy or chemoradiotherapy in rectal cancer - Is survival improved? An update of the "Nordic" LARC study in non-resectable cancers. Radiother Oncol. 2018 Jun;127(3):392-395. Epub 2018 May 16. link to original article PubMed
MRC CR07; NCIC-CTG CO.16: Sebag-Montefiore D, Stephens RJ, Steele R, Monson J, Grieve R, Khanna S, Quirke P, Couture J, de Metz C, Myint AS, Bessell E, Griffiths G, Thompson LC, Parmar M. Preoperative radiotherapy versus selective postoperative chemoradiotherapy in patients with rectal cancer (MRC CR07 and NCIC-CTG C016): a multicentre, randomised trial. Lancet. 2009 Mar 7;373(9666):811-20. link to original article link to PMC article contains dosing details in abstract PubMed NCT00003422
Polish II: Bujko K, Wyrwicz L, Rutkowski A, Malinowska M, Pietrzak L, Kryński J, Michalski W, Olędzki J, Kuśnierz J, Zając L, Bednarczyk M, Szczepkowski M, Tarnowski W, Kosakowska E, Zwoliński J, Winiarek M, Wiśniowska K, Partycki M, Bęczkowska K, Polkowski W, Styliński R, Wierzbicki R, Bury P, Jankiewicz M, Paprota K, Lewicka M, Ciseł B, Skórzewska M, Mielko J, Bębenek M, Maciejczyk A, Kapturkiewicz B, Dybko A, Hajac Ł, Wojnar A, Leśniak T, Zygulska J, Jantner D, Chudyba E, Zegarski W, Las-Jankowska M, Jankowski M, Kołodziejski L, Radkowski A, Żelazowska-Omiotek U, Czeremszyńska B, Kępka L, Kolb-Sielecki J, Toczko Z, Fedorowicz Z, Dziki A, Danek A, Nawrocki G, Sopyło R, Markiewicz W, Kędzierawski P, Wydmański J; Polish Colorectal Study Group. Long-course oxaliplatin-based preoperative chemoradiation versus 5 × 5 Gy and consolidation chemotherapy for cT4 or fixed cT3 rectal cancer: results of a randomized phase III study. Ann Oncol. 2016 May;27(5):834-42. Epub 2016 Feb 15. link to original article contains dosing details in abstract PubMed NCT00833131
1. Update: Ciseł B, Pietrzak L, Michalski W, Wyrwicz L, Rutkowski A, Kosakowska E, Cencelewicz A, Spałek M, Polkowski W, Jankiewicz M, Styliński R, Bębenek M, Kapturkiewicz B, Maciejczyk A, Sadowski J, Zygulska J, Zegarski W, Jankowski M, Las-Jankowska M, Toczko Z, Żelazowska-Omiotek U, Kępka L, Socha J, Wasilewska-Tesluk E, Markiewicz W, Kładny J, Majewski A, Kapuściński W, Suwiński R, Bujko K; Polish Colorectal Study Group. Long-course preoperative chemoradiation vs 5 x 5 Gy and consolidation chemotherapy for clinical T4 and fixed clinical T3 rectal cancer: long-term results of the randomized Polish II study. Ann Oncol. 2019 Aug 1;30(8):1298-1303. Epub 2019 Jun 13. link to original article PubMed
RAPIDO: Bahadoer RR, Dijkstra EA, van Etten B, Marijnen CAM, Putter H, Kranenbarg EM, Roodvoets AGH, Nagtegaal ID, Beets-Tan RGH, Blomqvist LK, Fokstuen T, Ten Tije AJ, Capdevila J, Hendriks MP, Edhemovic I, Cervantes A, Nilsson PJ, Glimelius B, van de Velde CJH, Hospers GAP; RAPIDO collaborative investigators. Short-course radiotherapy followed by chemotherapy before total mesorectal excision (TME) versus preoperative chemoradiotherapy, TME, and optional adjuvant chemotherapy in locally advanced rectal cancer (RAPIDO): a randomised, open-label, phase 3 trial. Lancet Oncol. 2021 Jan;22(1):29-42. Epub 2020 Dec 7. link to original article contains dosing details in manuscript PubMed NCT01558921

Adjuvant chemotherapy

Capecitabine monotherapy

Regimen variant #1, 2000 mg/m²/day x 6

Study	Years of enrollment	Evidence	Comparator	Comparative Efficacy
Schmoll et al. 2020 (PETACC 6)	2008-2011	Phase 3 (C)	CapeOx	Did not meet primary endpoint of DFS36

Note: this is a component of a sequential treatment protocol; to our knowledge there are no references to support using it as a stand-alone treatment.

Preceding treatment

Neoadjuvant capecitabine & RT, then surgery

Chemotherapy

Capecitabine (Xeloda) 1000 mg/m² PO twice per day on days 1 to 15

21-day cycle for 6 cycles

Regimen variant #2, 2500 mg/m²/day x 5

Study	Years of enrollment	Evidence	Comparator	Comparative Efficacy
Hofheinz et al. 2012 (Rektum-III)	2002-2007	Phase 3 (E-switch-ic)	Fluorouracil	Non-inferior OS

Note: this is a component of a sequential treatment protocol; to our knowledge there are no references to support using it as a stand-alone treatment.

Preceding treatment

Neoadjuvant capecitabine & RT, then surgery

Chemotherapy

Capecitabine (Xeloda) 1250 mg/m² PO twice per day on days 1 to 14

21-day cycle for 5 cycles

Regimen variant #3, 2500 mg/m²/day x 8

Study	Years of enrollment	Evidence	Comparator	Comparative Efficacy
Breugom et al. 2014 (SCRIPT)	2000-2013	Phase 3 (E-esc)	Observation	Did not meet primary endpoint of OS

Note: this is a component of a sequential treatment protocol; to our knowledge there are no references to support using it as a stand-alone treatment.

Preceding treatment

5-FU-based chemoradiotherapy or RT, then surgery

Chemotherapy

Capecitabine (Xeloda) 1250 mg/m² PO twice per day on days 1 to 14

21-day cycle for 8 cycles

References

Rektum-III: Hofheinz RD, Wenz F, Post S, Matzdorff A, Laechelt S, Hartmann JT, Müller L, Link H, Moehler M, Kettner E, Fritz E, Hieber U, Lindemann HW, Grunewald M, Kremers S, Constantin C, Hipp M, Hartung G, Gencer D, Kienle P, Burkholder I, Hochhaus A. Chemoradiotherapy with capecitabine versus fluorouracil for locally advanced rectal cancer: a randomised, multicentre, non-inferiority, phase 3 trial. Lancet Oncol. 2012 Jun;13(6):579-88. Epub 2012 Apr 12. link to original article contains dosing details in manuscript PubMed NCT01500993
SCRIPT: Breugom AJ, van Gijn W, Muller EW, Berglund Å, van den Broek CB, Fokstuen T, Gelderblom H, Kapiteijn E, Leer JW, Marijnen CA, Martijn H, Meershoek-Klein Kranenbarg E, Nagtegaal ID, Påhlman L, Punt CJ, Putter H, Roodvoets AG, Rutten HJ, Steup WH, Glimelius B, van de Velde CJ; Dutch Colorectal Cancer Group; Nordic Gastrointestinal Tumour Adjuvant Therapy Group. Adjuvant chemotherapy for rectal cancer patients treated with preoperative (chemo)radiotherapy and total mesorectal excision: a Dutch Colorectal Cancer Group (DCCG) randomized phase III trial. Ann Oncol. 2015 Apr;26(4):696-701. Epub 2014 Dec 5. link to original article contains dosing details in manuscript PubMed ISRCTN36266738
PETACC 6: Schmoll HJ, Stein A, Van Cutsem E, Price T, Hofheinz RD, Nordlinger B, Daisne JF, Janssens J, Brenner B, Reinel H, Hollerbach S, Caca K, Fauth F, Hannig CV, Zalcberg J, Tebbutt N, Mauer ME, Marreaud S, Lutz MP, Haustermans K. Pre- and Postoperative Capecitabine Without or With Oxaliplatin in Locally Advanced Rectal Cancer: PETACC 6 Trial by EORTC GITCG and ROG, AIO, AGITG, BGDO, and FFCD. J Clin Oncol. 2021 Jan 1;39(1):17-29. Epub 2020 Oct 1. link to original article contains dosing details in manuscript PubMed NCT00766155

Fluorouracil monotherapy

Regimen variant #1

Study	Years of enrollment	Evidence	Comparator	Comparative Efficacy
Hofheinz et al. 2012 (Rektum-III)	2002-2007	Phase 3 (C)	Capecitabine	Non-inferior OS

Preceding treatment

Neoadjuvant fluorouracil & RT, then surgery

Chemotherapy

Fluorouracil (5-FU) 500 mg/m² IV bolus once per day on days 1 to 5

28-day cycle for 4 cycles

Regimen variant #2

Study	Years of enrollment	Evidence	Comparator	Comparative Efficacy
Rödel et al. 2012 (CAO/ARO/AIO-04)	2006-2010	Phase 3 (C)	FOLFOX	Seems to have inferior DFS¹

¹Reported efficacy is based on the 2015 update.

Preceding treatment

Neoadjuvant fluorouracil & RT, then surgery

Chemotherapy

Fluorouracil (5-FU) 500 mg/m² IV bolus once per day on days 1 to 5, 29

4 cycles (length not specified)

References

Rektum-III: Hofheinz RD, Wenz F, Post S, Matzdorff A, Laechelt S, Hartmann JT, Müller L, Link H, Moehler M, Kettner E, Fritz E, Hieber U, Lindemann HW, Grunewald M, Kremers S, Constantin C, Hipp M, Hartung G, Gencer D, Kienle P, Burkholder I, Hochhaus A. Chemoradiotherapy with capecitabine versus fluorouracil for locally advanced rectal cancer: a randomised, multicentre, non-inferiority, phase 3 trial. Lancet Oncol. 2012 Jun;13(6):579-88. Epub 2012 Apr 12. link to original article contains dosing details in manuscript PubMed NCT01500993
CAO/ARO/AIO-04: Rödel C, Liersch T, Becker H, Fietkau R, Hohenberger W, Hothorn T, Graeven U, Arnold D, Lang-Welzenbach M, Raab HR, Sülberg H, Wittekind C, Potapov S, Staib L, Hess C, Weigang-Köhler K, Grabenbauer GG, Hoffmanns H, Lindemann F, Schlenska-Lange A, Folprecht G, Sauer R; 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. 2012 Jul;13(7):679-87. Epub 2012 May 23. link to original article contains dosing details in abstract PubMed NCT00349076
1. Update: Rödel C, Graeven U, Fietkau R, Hohenberger W, Hothorn T, Arnold D, Hofheinz RD, Ghadimi M, Wolff HA, Lang-Welzenbach M, Raab HR, Wittekind C, Ströbel P, Staib L, Wilhelm M, Grabenbauer GG, Hoffmanns H, Lindemann F, Schlenska-Lange A, Folprecht G, Sauer R, Liersch T; German Rectal Cancer Study Group. Oxaliplatin added to fluorouracil-based preoperative chemoradiotherapy and postoperative chemotherapy of locally advanced rectal cancer (the German CAO/ARO/AIO-04 study): final results of the multicentre, open-label, randomised, phase 3 trial. Lancet Oncol. 2015 Aug;16(8):979-89. Epub 2015 Jul 15. link to original article PubMed

FULV

FULV: 5-FU & LeucoVorin (Folinic acid)

Regimen variant #1, 500/500

Study	Years of enrollment	Evidence	Comparator	Comparative Efficacy
Wolmark et al. 2000 (NSABP R-02)	1987-1992	Phase 3 (C)	FULV & RT	Did not meet primary endpoint of OS60

Note: male patients were also randomized to MOF or MOF & RT; this is of historic interest, only.

Preceding treatment

Surgery

Chemotherapy

Fluorouracil (5-FU) 500 mg/m² IV once per day on days 1, 8, 15, 22, 29, 36, given 1 hour after leucovorin
Folinic acid (Leucovorin) 500 mg/m² IV once per day on days 1, 8, 15, 22, 29, 36, given first

8-week cycle for 6 cycles

Regimen variant #2, 1000/120 ("Nordic regimen")

Study	Years of enrollment	Evidence	Comparator	Comparative Efficacy
Breugom et al. 2014 (PROCTOR)	2000-2013	Phase 3 (E-esc)	Observation	Did not meet primary endpoint of OS

Note: this is an experimental arm that did not meet its primary endpoint; included here because other variants of this regimen have been used as a standard comparator. This is a component of a sequential treatment protocol; to our knowledge there are no references to support using it as a stand-alone treatment.

Preceding treatment

5-FU-based chemoradiotherapy or RT, then surgery

Chemotherapy

Fluorouracil (5-FU) 500 mg/m² IV once per day on days 1 & 2, given first (total dose per cycle: 1000 mg/m²)
Folinic acid (Leucovorin) 60 mg/m² IV once per day on days 1 & 2, given second (total dose per cycle: 120 mg/m²)

14-day cycle for 12 cycles

Regimen variant #3, 1900/100

Study	Years of enrollment	Evidence	Comparator	Comparative Efficacy
Hong et al. 2014 (ADORE)	2008-2012	Randomized Phase 2 (C)	FOLFOX	Seems to have inferior DFS

Note: this is a component of a sequential treatment protocol; to our knowledge there are no references to support using it as a stand-alone treatment.

Preceding treatment

Fluoropyrimidine-based chemoradiation, then TME

Chemotherapy

Fluorouracil (5-FU) 380 mg/m² IV once per day on days 1 to 5 (total dose per cycle: 1900 mg/m²)
Folinic acid (Leucovorin) 20 mg/m² IV once per day on days 1 to 5 (total dose per cycle: 100 mg/m²)

28-day cycle for 4 cycles

Regimen variant #4, 2125/100 ("Mayo regimen")

Study	Years of enrollment	Evidence	Comparator	Comparative Efficacy
Delbaldo et al. 2015 (R98)	1999-2005	Phase 3 (C)	FOLFIRI	Did not meet primary endpoint of DFS
Breugom et al. 2014 (PROCTOR)	2000-2013	Phase 3 (E-esc)	Observation	Did not meet primary endpoint of OS

Note: this is an experimental arm that did not meet its primary endpoint; included here because it was eventually used to establish this regimen as a standard comparator. This is a component of a sequential treatment protocol; to our knowledge there are no references to support using it as a stand-alone treatment.

Preceding treatment

PROCTOR: 5-FU-based chemoradiotherapy or RT, then surgery

Chemotherapy

Fluorouracil (5-FU) 425 mg/m² IV once per day on days 1 to 5 (total dose per cycle: 2125 mg/m²)
Folinic acid (Leucovorin) 20 mg/m² IV once per day on days 1 to 5 (total dose per cycle: 100 mg/m²)

4- to 5-week cycle for 6 cycles

References

NSABP R-02: Wolmark N, Wieand HS, Hyams DM, Colangelo L, Dimitrov NV, Romond EH, Wexler M, Prager D, Cruz AB Jr, Gordon PH, Petrelli NJ, Deutsch M, Mamounas E, Wickerham DL, Fisher ER, Rockette H, Fisher B. Randomized trial of postoperative adjuvant chemotherapy with or without radiotherapy for carcinoma of the rectum: National Surgical Adjuvant Breast and Bowel Project Protocol R-02. J Natl Cancer Inst. 2000 Mar 1;92(5):388-96. link to original article contains dosing details in manuscript PubMed
ADORE: Hong YS, Nam BH, Kim KP, Kim JE, Park SJ, Park YS, Park JO, Kim SY, Kim TY, Kim JH, Ahn JB, Lim SB, Yu CS, Kim JC, Yun SH, Kim JH, Park JH, Park HC, Jung KH, Kim TW. Oxaliplatin, fluorouracil, and leucovorin versus fluorouracil and leucovorin as adjuvant chemotherapy for locally advanced rectal cancer after preoperative chemoradiotherapy (ADORE): an open-label, multicentre, phase 2, randomised controlled trial. Lancet Oncol. 2014 Oct;15(11):1245-53. Epub 2014 Sep 4. link to original article contains dosing details in abstract PubMed NCT00807911
1. Update: Hong YS, Kim SY, Lee JS, Nam BH, Kim KP, Kim JE, Park YS, Park JO, Baek JY, Kim TY, Lee KW, Ahn JB, Lim SB, Yu CS, Kim JC, Yun SH, Kim JH, Park JH, Park HC, Jung KH, Kim TW. Oxaliplatin-Based Adjuvant Chemotherapy for Rectal Cancer After Preoperative Chemoradiotherapy (ADORE): Long-Term Results of a Randomized Controlled Trial. J Clin Oncol. 2019 Nov 20;37(33):3111-3123. Epub 2019 Oct 8. link to original article PubMed
PROCTOR: Breugom AJ, van Gijn W, Muller EW, Berglund Å, van den Broek CB, Fokstuen T, Gelderblom H, Kapiteijn E, Leer JW, Marijnen CA, Martijn H, Meershoek-Klein Kranenbarg E, Nagtegaal ID, Påhlman L, Punt CJ, Putter H, Roodvoets AG, Rutten HJ, Steup WH, Glimelius B, van de Velde CJ; Dutch Colorectal Cancer Group; Nordic Gastrointestinal Tumour Adjuvant Therapy Group. Adjuvant chemotherapy for rectal cancer patients treated with preoperative (chemo)radiotherapy and total mesorectal excision: a Dutch Colorectal Cancer Group (DCCG) randomized phase III trial. Ann Oncol. 2015 Apr;26(4):696-701. Epub 2014 Dec 5. link to original article contains dosing details in manuscript PubMed ISRCTN36266738
R98: Delbaldo C, Ychou M, Zawadi A, Douillard JY, André T, Guerin-Meyer V, Rougier P, Dupuis O, Faroux R, Jouhaud A, Quinaux E, Buyse M, Piedbois P; AERO; GERCOR; FNCLCC; FFCD. Postoperative irinotecan in resected stage II-III rectal cancer: final analysis of the French R98 Intergroup trial. Ann Oncol. 2015 Jun;26(6):1208-15. Epub 2015 Mar 3. link to original article PubMed

mFOLFOX6

mFOLFOX6: FOLinic acid, Fluorouracil, OXaliplatin

Regimen variant #1, with 5-FU bolus, 8 cycles

Study	Years of enrollment	Evidence	Comparator	Comparative Efficacy
Hong et al. 2014 (ADORE)	2008-2012	Randomized Phase 2 (E-esc)	FULV	Seems to have superior DFS DFS36: 71.6% vs 62.9% (HR 0.66, 95% CI 0.43-0.994)

Preceding treatment

Fluoropyrimidine-based chemoradiation, then TME

Chemotherapy

Fluorouracil (5-FU) 400 mg/m² IV bolus on day 1, then 2400 mg/m² IV continuous infusion over 46 hours (total dose per cycle: 2800 mg/m²)
Folinic acid (Leucovorin) 200 mg/m² IV once on day 1
Oxaliplatin (Eloxatin) 85 mg/m² IV once on day 1

14-day cycle for 8 cycles

Regimen variant #2, no 5-FU bolus, 8 cycles

Study	Years of enrollment	Evidence	Comparator	Comparative Efficacy
Rödel et al. 2012 (CAO/ARO/AIO-04)	2006-2010	Phase 3 (E-esc)	Fluorouracil	Seems to have superior DFS¹ DFS36: 75.95% vs 71.2% (HR 0.79, 95% CI 0.64-0.98)

¹Reported efficacy is based on the 2015 update.

Preceding treatment

Neoadjuvant FUOX & RT, then surgery

Chemotherapy

Fluorouracil (5-FU) 2400 mg/m² IV continuous infusion over 46 hours, started on day 1, given third (total dose per cycle: 2400 mg/m²)
Folinic acid (Leucovorin) 400 mg/m² IV over 2 hours once on day 1, given second
Oxaliplatin (Eloxatin) 100 mg/m² IV over 2 hours once on day 1, given first

14-day cycle for 8 cycles

Regimen variant #3, 12 cycles

Study	Years of enrollment	Evidence	Comparator	Comparative Efficacy
Chakravarthy et al. 2019 (ECOG E5204)	2006-2009 (T)	Phase 3 (C)	mFOLFOX6-B	Did not meet primary endpoint of OS OS60: 88.3% vs 83.7%

Preceding treatment

Fluoropyrimidine-based chemoradiation, then TME

Chemotherapy

Fluorouracil (5-FU) 400 mg/m² IV bolus on day 1, then 2400 mg/m² IV continuous infusion over 46 hours (total dose per cycle: 2800 mg/m²)
Folinic acid (Leucovorin) 400 mg/m² IV over 2 hours once on day 1
Oxaliplatin (Eloxatin) 85 mg/m² IV over 2 hours once on day 1

14-day cycle for 12 cycles

References

ADORE: Hong YS, Nam BH, Kim KP, Kim JE, Park SJ, Park YS, Park JO, Kim SY, Kim TY, Kim JH, Ahn JB, Lim SB, Yu CS, Kim JC, Yun SH, Kim JH, Park JH, Park HC, Jung KH, Kim TW. Oxaliplatin, fluorouracil, and leucovorin versus fluorouracil and leucovorin as adjuvant chemotherapy for locally advanced rectal cancer after preoperative chemoradiotherapy (ADORE): an open-label, multicentre, phase 2, randomised controlled trial. Lancet Oncol. 2014 Oct;15(11):1245-53. Epub 2014 Sep 4. link to original article contains dosing details in abstract PubMed NCT00807911
1. Update: Hong YS, Kim SY, Lee JS, Nam BH, Kim KP, Kim JE, Park YS, Park JO, Baek JY, Kim TY, Lee KW, Ahn JB, Lim SB, Yu CS, Kim JC, Yun SH, Kim JH, Park JH, Park HC, Jung KH, Kim TW. Oxaliplatin-Based Adjuvant Chemotherapy for Rectal Cancer After Preoperative Chemoradiotherapy (ADORE): Long-Term Results of a Randomized Controlled Trial. J Clin Oncol. 2019 Nov 20;37(33):3111-3123. Epub 2019 Oct 8. link to original article PubMed
CAO/ARO/AIO-04: Rödel C, Liersch T, Becker H, Fietkau R, Hohenberger W, Hothorn T, Graeven U, Arnold D, Lang-Welzenbach M, Raab HR, Sülberg H, Wittekind C, Potapov S, Staib L, Hess C, Weigang-Köhler K, Grabenbauer GG, Hoffmanns H, Lindemann F, Schlenska-Lange A, Folprecht G, Sauer R; 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. 2012 Jul;13(7):679-87. Epub 2012 May 23. link to original article contains dosing details in manuscript PubMed NCT00349076
1. Update: Rödel C, Graeven U, Fietkau R, Hohenberger W, Hothorn T, Arnold D, Hofheinz RD, Ghadimi M, Wolff HA, Lang-Welzenbach M, Raab HR, Wittekind C, Ströbel P, Staib L, Wilhelm M, Grabenbauer GG, Hoffmanns H, Lindemann F, Schlenska-Lange A, Folprecht G, Sauer R, Liersch T; German Rectal Cancer Study Group. Oxaliplatin added to fluorouracil-based preoperative chemoradiotherapy and postoperative chemotherapy of locally advanced rectal cancer (the German CAO/ARO/AIO-04 study): final results of the multicentre, open-label, randomised, phase 3 trial. Lancet Oncol. 2015 Aug;16(8):979-89. Epub 2015 Jul 15. link to original article PubMed
ECOG E5204: Chakravarthy AB, Zhao F, Meropol NJ, Flynn PJ, Wagner LI, Sloan J, Diasio RB, Mitchell EP, Catalano P, Giantonio BJ, Catalano RB, Haller DG, Awan RA, Mulcahy MF, O'Brien TE, Santala R, Cripps C, Weis JR, Atkins JN, Leichman CG, Petrelli NJ, Sinicrope FA, Brierley JD, Tepper JE, O'Dwyer PJ, Sigurdson ER, Hamilton SR, Cella D, Benson AB 3rd. Intergroup Randomized Phase III Study of Postoperative Oxaliplatin, 5-Fluorouracil, and Leucovorin Versus Oxaliplatin, 5-Fluorouracil, Leucovorin, and Bevacizumab for Patients with Stage II or III Rectal Cancer Receiving Preoperative Chemoradiation: A Trial of the ECOG-ACRIN Research Group (E5204). Oncologist. 2020 May;25(5):e798-e807. Epub 2019 Dec 18. link to original article link to PMC article contains dosing details in manuscript PubMed NCT00303628

S-1 monotherapy

Regimen

Study	Years of enrollment	Evidence	Comparator	Comparative Efficacy
Oki et al. 2016 (ACTS-RC)	2006-2009	Phase 3 (E-switch-ic)	UFT	Seems to have superior RFS

Note: these patients did not receive preoperative therapy.

Preceding treatment

Curative resection for stage II or stage III rectal cancer, within 49 days

Chemotherapy

Tegafur, gimeracil, oteracil (S-1) by the following criteria:
- BSA less than 1.25 m²: 40 mg PO twice per day on days 1 to 28
- BSA 1.25 to 1.5 m²: 50 mg PO twice per day on days 1 to 28
- BSA 1.5 or greater m²: 60 mg PO twice per day on days 1 to 28

42-day cycle for 9 cycles (1 year)

References

ACTS-RC: Oki E, Murata A, Yoshida K, Maeda K, Ikejiri K, Munemoto Y, Sasaki K, Matsuda C, Kotake M, Suenaga T, Matsuda H, Emi Y, Kakeji Y, Baba H, Hamada C, Saji S, Maehara Y. A randomized phase III trial comparing S-1 versus UFT as adjuvant chemotherapy for stage II/III rectal cancer (JFMC35-C1: ACTS-RC). Ann Oncol. 2016 Jul;27(7):1266-72. Epub 2016 Apr 7. link to original article link to PMC article contains dosing details in manuscript PubMed UMIN C000000385

UFT monotherapy

Regimen

Study	Years of enrollment	Evidence	Comparator	Comparative Efficacy
Hamaguchi et al. 2010 (NSAS-CC)	1996-2001	Phase 3 (E-esc)	Observation	Seems to have superior OS
Oki et al. 2016 (ACTS-RC)	2006-2009	Phase 3 (C)	S-1	Seems to have inferior RFS

Note: these patients did not receive preoperative therapy.

Preceding treatment

Curative resection for stage II or stage III rectal cancer, within 49 days

Chemotherapy

Tegafur and uracil (UFT) by the following criteria:
- BSA less than 1.25 m²: 250 mg PO twice per day on days 1 to 5
- BSA 1.25 or greater m²: 300 mg PO twice per day on days 1 to 5

7-day cycle for 52 cycles

References

NSAS-CC: Hamaguchi T, Shirao K, Moriya Y, Yoshida S, Kodaira S, Ohashi Y; NSAS-CC Group. Final results of randomized trials by the National Surgical Adjuvant Study of Colorectal Cancer (NSAS-CC). Cancer Chemother Pharmacol. 2011 Mar;67(3):587-96. Epub 2010 May 19. link to original article PubMed NCT00152230
ACTS-RC: Oki E, Murata A, Yoshida K, Maeda K, Ikejiri K, Munemoto Y, Sasaki K, Matsuda C, Kotake M, Suenaga T, Matsuda H, Emi Y, Kakeji Y, Baba H, Hamada C, Saji S, Maehara Y. A randomized phase III trial comparing S-1 versus UFT as adjuvant chemotherapy for stage II/III rectal cancer (JFMC35-C1: ACTS-RC). Ann Oncol. 2016 Jul;27(7):1266-72. Epub 2016 Apr 7. link to original article link to PMC article contains dosing details in manuscript PubMed UMIN C000000385

Adjuvant chemoradiotherapy

Capecitabine/Capecitabine & RT

Capecitabine/Capecitabine & RT: Capecitabine alternating with Capecitabine & Radiation Therapy

Protocol

Study	Years of enrollment	Evidence	Comparator	Comparative Efficacy
Hofheinz et al. 2012 (Rektum-III)	2002-2007	Phase 3 (E-switch-ic)	5-FU/5-FU & RT	Non-inferior OS

Preceding treatment

Surgery

Chemotherapy, part 1

Capecitabine (Xeloda) 1250 mg/m² PO twice per day on days 1 to 14

21-day cycle for 2 cycles, followed by:

Chemotherapy, part 2

Capecitabine (Xeloda) 825 mg/m² PO twice per day on days 1 to 38

Radiotherapy

Concurrent radiation therapy, 50.4 Gy total

Followed by:

Chemotherapy, part 3

Capecitabine (Xeloda) 1250 mg/m² PO twice per day on days 1 to 14

21-day cycle for 3 cycles

References

Rektum-III: Hofheinz RD, Wenz F, Post S, Matzdorff A, Laechelt S, Hartmann JT, Müller L, Link H, Moehler M, Kettner E, Fritz E, Hieber U, Lindemann HW, Grunewald M, Kremers S, Constantin C, Hipp M, Hartung G, Gencer D, Kienle P, Burkholder I, Hochhaus A. Chemoradiotherapy with capecitabine versus fluorouracil for locally advanced rectal cancer: a randomised, multicentre, non-inferiority, phase 3 trial. Lancet Oncol. 2012 Jun;13(6):579-88. Epub 2012 Apr 12. link to original article contains dosing details in manuscript PubMed NCT01500993

Capecitabine & RT

Capecitabine & RT: Capecitabine & Radiation Therapy

Regimen

Study	Years of enrollment	Evidence	Comparator	Comparative Efficacy
Feng et al. 2016 (CAMS rectal cancer 01)	2008-2014	Phase 3 (C)	CapeOx & RT	Did not meet primary endpoint of DFS DFS36: 71.6% vs 73.9%

Preceding treatment

Surgery

Chemotherapy

Capecitabine (Xeloda) 800 mg/m² PO twice per day on days 1 to 14

21-day cycle for 2 cycles

Radiotherapy

Concurrent radiation therapy, 45 to 50.4 Gy total in 25 to 28 fractions

5- to 5.5-week course

References

CAMS rectal cancer 01: Feng YR, Zhu Y, Liu LY, Wang WH, Wang SL, Song YW, Wang X, Tang Y, Liu YP, Ren H, Fang H, Zhang SP, Liu XF, Yu ZH, Li YX, Jin J. Interim analysis of postoperative chemoradiotherapy with capecitabine and oxaliplatin versus capecitabine alone for pathological stage II and III rectal cancer: a randomized multicenter phase III trial. Oncotarget. 2016 May 3;7(18):25576-84. link to original article link to PMC article contains dosing details in manuscript PubMed NCT00714077

Fluorouracil & RT

Fluorouracil & RT: Fluorouracil & Radiation Therapy

Regimen

Study	Years of enrollment	Evidence	Comparator	Comparative Efficacy
Fountzilas et al. 1999	1989-1997	Phase 3 (C)	FULV/5-FU & RT	Did not meet primary endpoint of OS36

Chemotherapy

Fluorouracil (5-FU)

Radiotherapy

Radiation therapy

References

Fountzilas G, Zisiadis A, Dafni U, Konstantaras C, Hatzitheoharis G, Liaros A, Athanassiou E, Dombros N, Dervenis C, Basdanis G, Gamvros O, Souparis A, Briasoulis E, Samantas E, Kappas A, Kosmidis P, Skarlos D, Pavlidis N; Hellenic Cooperative Oncology Group. Postoperative radiation and concomitant bolus fluorouracil with or without additional chemotherapy with fluorouracil and high-dose leucovorin in patients with high-risk rectal cancer: a randomized phase III study conducted by the Hellenic Cooperative Oncology Group. Ann Oncol. 1999 Jun;10(6):671-6. link to original article PubMed

Fluorouracil/Fluorouracil & RT

Fluorouracil/Fluorouracil & RT: Fluorouracil alternating with Fluorouracil & Radiation Therapy

Protocol variant #1, Bolus 5-FU (500 mg/m²), then CI 5-FU & RT, then Bolus 5-FU (450 mg/m²)

Study	Years of enrollment	Evidence	Comparator	Comparative Efficacy
O'Connell et al. 1994 (INT 864751)	1986-1990	Phase 3 (E-switch-ic)	5-FU/5-FU & RT; bolus	Superior OS
Smalley et al. 2006 (GI INT 0144)	1994-2000	Phase 3 (E-switch-ic)	1. Bolus 5-FU/RT	Not compared
Smalley et al. 2006 (GI INT 0144)	1994-2000	Phase 3 (E-switch-ic)	2. 5-FU/5-FU & RT; CI	Did not meet primary endpoints of OS/DFS

Note: INT 864751 also included a randomization to add semustine, which is only of historic interest.

Preceding treatment

Surgery

Chemotherapy, part 1

Fluorouracil (5-FU) 500 mg/m² IV bolus once per day on days 1 to 5

28-day cycle for 2 cycles, followed immediately by:

Chemotherapy, part 2

Fluorouracil (5-FU) 225 mg/m²/day IV continuous infusion while radiation is being given

Radiotherapy

Concurrent radiation therapy, 1.8 Gy fractions x 25 fractions for an initial dose of 45 Gy, which is followed by a 1.8 Gy x 3 fraction (5.4 Gy total) boost to the tumor bed and adjacent lymph nodes, and then optionally a 1.8 Gy x 2 fraction (3.6 Gy total) boost to the tumor bed and a 2 cm margin if the small bowel could be avoided

6-week course, followed 28 days later by:

Chemotherapy, part 3

Fluorouracil (5-FU) 450 mg/m² IV bolus once per day on days 1 to 5

28-day cycle for 2 cycles

Protocol variant #2, Bolus 5-FU (500 mg/m²), then CI 5-FU & RT, then Bolus 5-FU (500 mg/m²)

Study	Years of enrollment	Evidence	Comparator	Comparative Efficacy
Hofheinz et al. 2012 (Rektum-III)	2002-2007	Phase 3 (C)	Capecitabine/Capecitabine & RT	Non-inferior OS

Preceding treatment

Surgery

Chemotherapy, part 1

Fluorouracil (5-FU) 500 mg/m² IV bolus once per day on days 1 to 5

28-day cycle for 2 cycles, followed by:

Chemotherapy, part 2

Fluorouracil (5-FU) 225 mg/m²/day IV continuous infusion while radiation is being given

Radiotherapy

Concurrent radiation therapy, 50.4 Gy total

Followed by:

Chemotherapy, part 3

Fluorouracil (5-FU) 500 mg/m² IV bolus once per day on days 1 to 5

28-day cycle for 2 cycles

Protocol variant #3, CI 5-FU, then CI 5-FU & RT, then CI 5-FU

Study	Years of enrollment	Evidence	Comparator	Comparative Efficacy
Smalley et al. 2006 (GI INT 0144)	1994-2000	Phase 3 (E-switch-ic)	1. 5-FU/5-FU & RT; bolus	Did not meet primary endpoints of DFS/OS
Smalley et al. 2006 (GI INT 0144)	1994-2000	Phase 3 (E-switch-ic)	2. Bolus 5-FU/RT	Not compared

Preceding treatment

Surgery

Chemotherapy, part 1

Fluorouracil (5-FU) 300 mg/m²/day IV continuous infusion over 42 days, started on day 1 (total dose: 12,600 mg/m²)

8-week course, followed in 2 weeks by:

Chemotherapy, part 2

Fluorouracil (5-FU) 225 mg/m²/day IV continuous infusion while radiation is being given

Radiotherapy

Concurrent radiation therapy, 1.8 Gy fractions x 25 fractions for an initial dose of 45 Gy, which is followed by a 1.8 Gy x 3 fraction (5.4 Gy total) boost to the tumor bed and adjacent lymph nodes, and then optionally a 1.8 Gy x 2 fraction (3.6 Gy total) boost to the tumor bed and a 2 cm margin if the small bowel could be avoided

Followed in 28 days by:

Chemotherapy, part 3

Fluorouracil (5-FU) 300 mg/m²/day IV continuous infusion over 56 days, started on day 1 (total dose: 16,800 mg/m²)

56-day course

Protocol variant #4, bolus 5-FU, then bolus 5-FU & RT, then bolus 5-FU

Study	Years of enrollment	Evidence	Comparator	Comparative Efficacy
O'Connell et al. 1994 (INT 864751)	1986-1990	Phase 3 (C)	Bolus 5-FU/CI 5-FU & RT	Inferior OS
Tepper et al. 1997 (GI INT 0114)	1990-1992	Phase 3 (C)	1. FULV/FULV & RT	Did not meet primary endpoint of DFS36
			2. Levamisole combination #1	Did not meet primary endpoint of DFS36
			3. Levamisole combination #2	Did not meet primary endpoint of DFS36

Note: INT 864751 also included a randomization to add semustine, which is only of historic interest.

Preceding treatment

Surgery

Chemotherapy, part 1

Fluorouracil (5-FU) 500 mg/m² IV bolus once per day on days 1 to 5

28-day cycle for 2 cycles, followed by:

Chemotherapy, part 2

Fluorouracil (5-FU) 500 mg/m² IV bolus 3 days per week during weeks 1 & 5 of radiation, preferably within 2 hours after the day's radiation

Radiotherapy

Concurrent radiation therapy, 1.8 Gy fractions x 25 fractions for an initial dose of 45 Gy, which is followed by a 1.8 Gy x 3 fraction (5.4 Gy total) boost to the tumor bed and adjacent lymph nodes, and then optionally a 1.8 Gy x 2 fraction (3.6 Gy total) boost to the tumor bed and a 2 cm margin if the small bowel could be avoided

Followed in 28 days by:

Chemotherapy, part 3

Fluorouracil (5-FU) 450 mg/m² IV bolus once per day on days 1 to 5

28-day cycle for 2 cycles

References

INT 864751: O'Connell MJ, Martenson JA, Wieand HS, Krook JE, Macdonald JS, Haller DG, Mayer RJ, Gunderson LL, Rich TA. Improving adjuvant therapy for rectal cancer by combining protracted-infusion fluorouracil with radiation therapy after curative surgery. N Engl J Med. 1994 Aug 25;331(8):502-7. link to original article contains dosing details in manuscript PubMed
GI INT 0114: Tepper JE, O'Connell MJ, Petroni GR, Hollis D, Cooke E, Benson AB 3rd, Cummings B, Gunderson LL, Macdonald JS, Martenson JA. Adjuvant postoperative fluorouracil-modulated chemotherapy combined with pelvic radiation therapy for rectal cancer: initial results of intergroup 0114. J Clin Oncol. 1997 May;15(5):2030-9. link to original article contains dosing details in manuscript PubMed
1. Update: Tepper JE, O'Connell M, Niedzwiecki D, Hollis DR, Benson AB 3rd, Cummings B, Gunderson LL, Macdonald JS, Martenson JA, Mayer RJ. Adjuvant therapy in rectal cancer: analysis of stage, sex, and local control--final report of intergroup 0114. J Clin Oncol. 2002 Apr 1;20(7):1744-50. link to original article contains dosing details in manuscript PubMed content property of HemOnc.org
GI INT 0144: Smalley SR, Benedetti JK, Williamson SK, Robertson JM, Estes NC, Maher T, Fisher B, Rich TA, Martenson JA, Kugler JW, Benson AB 3rd, Haller DG, Mayer RJ, Atkins JN, Cripps C, Pedersen J, Periman PO, Tanaka MS Jr, Leichman CG, Macdonald JS. Phase III trial of fluorouracil-based chemotherapy regimens plus radiotherapy in postoperative adjuvant rectal cancer: GI INT 0144. J Clin Oncol. 2006 Aug 1;24(22):3542-7. link to original article contains dosing details in manuscript PubMed NCT00002551
Rektum-III: Hofheinz RD, Wenz F, Post S, Matzdorff A, Laechelt S, Hartmann JT, Müller L, Link H, Moehler M, Kettner E, Fritz E, Hieber U, Lindemann HW, Grunewald M, Kremers S, Constantin C, Hipp M, Hartung G, Gencer D, Kienle P, Burkholder I, Hochhaus A. Chemoradiotherapy with capecitabine versus fluorouracil for locally advanced rectal cancer: a randomised, multicentre, non-inferiority, phase 3 trial. Lancet Oncol. 2012 Jun;13(6):579-88. Epub 2012 Apr 13. link to original article contains dosing details in manuscript PubMed NCT01500993

FULV/FULV & RT

FULV/FULV & RT: FluoroUracil & LeucoVorin (Folinic acid) alternating with FluoroUracil, LeucoVorin (Folinic acid) & Radiation Therapy

Protocol

Study	Years of enrollment	Evidence	Comparator	Comparative Efficacy
Tepper et al. 1997 (GI INT 0114)	1990-1992	Phase 3 (E-esc)	1. 5-FU/5-FU & RT	Did not meet primary endpoint of DFS36
			2. Levamisole combination #1	Did not meet primary endpoint of DFS36
			3. Levamisole combination #2	Did not meet primary endpoint of DFS36
Kalofonos et al. 2008	1999-2004	Phase 3 (C)	IFL & RT	Did not meet primary endpoint of OS36

Preceding treatment

Surgery

Chemotherapy, part 1

Fluorouracil (5-FU) 425 mg/m² IV bolus once per day on days 1 to 5, given second
Folinic acid (Leucovorin) 20 mg/m² IV bolus once per day on days 1 to 5, given first

28-day cycle for 2 cycles, followed by:

Chemotherapy, part 2

Fluorouracil (5-FU) 400 mg/m² IV bolus 4 days per week during weeks 1 & 5 of radiation, preferably within 2 hours after the day's radiation
Folinic acid (Leucovorin) 20 mg/m² IV bolus 4 days per week during weeks 1 & 5 of radiation, preferably within 2 hours after the day's radiation

Radiotherapy

Concurrent radiation therapy, 1.8 Gy fractions x 25 fractions for an initial dose of 45 Gy, which is followed by a 1.8 Gy x 3 fraction (5.4 Gy total) boost to the tumor bed and adjacent lymph nodes, and then optionally a 1.8 Gy x 2 fraction (3.6 Gy total) boost to the tumor bed and a 2 cm margin if the small bowel could be avoided

Followed in 28 days by:

Chemotherapy, part 3

Fluorouracil (5-FU) 380 mg/m² IV bolus once per day on days 1 to 5
Folinic acid (Leucovorin) 20 mg/m² IV bolus once per day on days 1 to 5

28-day cycle for 2 cycles

References

GI INT 0114: Tepper JE, O'Connell MJ, Petroni GR, Hollis D, Cooke E, Benson AB 3rd, Cummings B, Gunderson LL, Macdonald JS, Martenson JA. Adjuvant postoperative fluorouracil-modulated chemotherapy combined with pelvic radiation therapy for rectal cancer: initial results of intergroup 0114. J Clin Oncol. 1997 May;15(5):2030-9. link to original article contains dosing details in manuscript PubMed
1. Update: Tepper JE, O'Connell M, Niedzwiecki D, Hollis DR, Benson AB 3rd, Cummings B, Gunderson LL, Macdonald JS, Martenson JA, Mayer RJ. Adjuvant therapy in rectal cancer: analysis of stage, sex, and local control--final report of intergroup 0114. J Clin Oncol. 2002 Apr 1;20(7):1744-50. link to original article contains dosing details in manuscript PubMed
Kalofonos HP, Bamias A, Koutras A, Papakostas P, Basdanis G, Samantas E, Karina M, Misailidou D, Pisanidis N, Pentheroudakis G, Economopoulos T, Papadimitriou C, Skarlos DV, Pectasides D, Stavropoulos M, Bafaloukos D, Kardamakis D, Karanikiotis C, Vourli G, Fountzilas G; Hellenic Cooperative Oncology Group. A randomised phase III trial of adjuvant radio-chemotherapy comparing Irinotecan, 5FU and Leucovorin to 5FU and Leucovorin in patients with rectal cancer: a Hellenic Cooperative Oncology Group Study. Eur J Cancer. 2008 Aug;44(12):1693-700. Epub 2008 Jul 17. link to original article PubMed

Radiation therapy

RT: Radiation Therapy

Regimen

Study	Years of enrollment	Evidence	Comparator	Comparative Efficacy
Fisher et al. 1988 (NSABP R-01)	1977-1986	Phase 3 (E-esc)	1. MOF	Not reported
Fisher et al. 1988 (NSABP R-01)	1977-1986	Phase 3 (E-esc)	2. Observation	Did not meet efficacy endpoints of DFS/OS
Krook et al. 1991	1980-1986	Phase 3 (C)	Fluorouracil & RT	Inferior RFS
Amott et al. 1996	1984-1989	Phase 3 (E-esc)	Observation	Superior local recurrence rate

Note: this regimen is of historic interest.

Preceding treatment

Surgery

Radiotherapy

Radiation therapy, 40 to 50.4 Gy

4-week course

References

NSABP R-01: Fisher B, Wolmark N, Rockette H, Redmond C, Deutsch M, Wickerham DL, Fisher ER, Caplan R, Jones J, Lerner H, Gordon P, Feldman M, Cruz A, Legault-Poisson S, Wexler M, Lawrence W, Robidoux A. Postoperative adjuvant chemotherapy or radiation therapy for rectal cancer: results from NSABP protocol R-01. J Natl Cancer Inst. 1988 Mar 2;80(1):21-9. link to original article PubMed
Krook JE, Moertel CG, Gunderson LL, Wieand HS, Collins RT, Beart RW, Kubista TP, Poon MA, Meyers WC, Mailliard JA, Twito DI, Morton RF, Veeder MH, Witzig TE, Cha S, Vidyarthi SC. Effective surgical adjuvant therapy for high-risk rectal carcinoma. N Engl J Med. 1991 Mar 14;324(11):709-15. link to original article PubMed
Amott SJ, Stenning SP, Hardcastle JD; Medical Research Council Rectal Cancer Working Party. Randomised trial of surgery alone versus surgery followed by radiotherapy for mobile cancer of the rectum. Lancet. 1996 Dec 14;348(9042):1610-4. link to original article contains dosing details in abstract PubMed
TROG 01.014: Ngan SY, Burmeister B, Fisher RJ, Solomon M, Goldstein D, Joseph D, Ackland SP, Schache D, McClure B, McLachlan SA, McKendrick J, Leong T, Hartopeanu C, Zalcberg J, Mackay J. Randomized trial of short-course radiotherapy versus long-course chemoradiation comparing rates of local recurrence in patients with T3 rectal cancer: Trans-Tasman Radiation Oncology Group trial 01.04. J Clin Oncol. 2012 Nov 1;30(31):3827-33. Epub 2012 Sep 24. Erratum in: J Clin Oncol. 2013 Jan 20;31(3):399. link to original article PubMed NCT00351598

Advanced or metastatic disease

See the colorectal cancer page for colorectal cancer regimens.

@@ Line 12: / Line 12: @@
 |}
 {{TOC limit|limit=3}}
 =Guidelines=
 ==[http://www.esmo.org/ ESMO]==
@@ Line 19: / Line 18: @@
 ===Older===
 *'''2013:''' Glimelius et al. [http://annonc.oxfordjournals.org/content/24/suppl_6/vi81.full.pdf+html Rectal cancer: ESMO Clinical Practice Guidelines for diagnosis, treatment and follow-up] [https://pubmed.ncbi.nlm.nih.gov/24078665 PubMed]
 ==[https://www.nccn.org/ NCCN]==
 *[https://www.nccn.org/professionals/physician_gls/pdf/rectal.pdf NCCN Guidelines - Rectal Cancer]
 ==SIOG==
 *'''2018''': Montroni, Isacco et al. [https://doi.org/10.1016/j.ejso.2018.08.003 Personalized management of elderly patients with rectal cancer: Expert recommendations of the European Society of Surgical Oncology, European Society of Coloproctology, International Society of Geriatric Oncology, and American College of Surgeons Commission on Cancer.]
 =Neoadjuvant therapy=
 ==Capecitabine & RT {{#subobject:1887b9|Regimen=1}}==
 Capecitabine & RT: Capecitabine & '''<u>R</u>'''adiation '''<u>T</u>'''herapy
+<div class="toccolours" style="background-color:#eeeeee">
 ===Regimen variant #1, interrupted capecitabine, 1600 mg/m<sup>2</sup>/day, 45 Gy {{#subobject:19cc2a|Variant=1}}===
 {| class="wikitable sortable" style="width: 100%; text-align:center;"
@@ Line 46: / Line 42: @@
 |}
 ''Note: adjuvant therapy was not specified. Treatment is assumed to start on a Monday.''
+<div class="toccolours" style="background-color:#b3e2cd">
 ====Chemotherapy====
 *[[Capecitabine (Xeloda)]] 800 mg/m<sup>2</sup> PO twice per day on days 1 to 5
@@ Line 51: / Line 48: @@
 ====Radiotherapy====
 *Concurrent [[External_beam_radiotherapy|radiation therapy]], 45 Gy total in 25 fractions
 '''5-week course'''
+</div>
+<div class="toccolours" style="background-color:#cbd5e7">
 ====Subsequent treatment====
 *[[Surgery#Colorectal_cancer_surgery|Surgery]]
+</div></div><br>
+<div class="toccolours" style="background-color:#eeeeee">
 ===Regimen variant #2, interrupted capecitabine, 1600 mg/m<sup>2</sup>/day, 50 Gy {{#subobject:19ff2a|Variant=1}}===
 {| class="wikitable sortable" style="width: 60%; text-align:center;"
@@ Line 68: / Line 67: @@
 |}
 ''Note: Treatment is assumed to start on a Monday.''
+<div class="toccolours" style="background-color:#cbd5e8">
 ====Preceding treatment====
 *[[#FOLFIRINOX|FOLFIRINOX]] versus [[Rectal_cancer_-_null_regimens#No_neoadjuvant_therapy|no neoadjuvant chemotherapy]]
+</div>
+<div class="toccolours" style="background-color:#b3e2cd">
 ====Chemotherapy====
 *[[Capecitabine (Xeloda)]] 800 mg/m<sup>2</sup> PO twice per day on days 1 to 5
@@ Line 75: / Line 77: @@
 ====Radiotherapy====
 *Concurrent [[External_beam_radiotherapy|radiation therapy]], 50 Gy total in 25 fractions
 '''5-week course'''
+</div>
+<div class="toccolours" style="background-color:#cbd5e7">
 ====Subsequent treatment====
 *[[Surgery#Total_mesorectal_excision|TME]], then [[#mFOLFOX6_88|mFOLFOX6]]
+</div></div><br>
+<div class="toccolours" style="background-color:#eeeeee">
 ===Regimen variant #3, interrupted capecitabine, 1650 mg/m<sup>2</sup>/day, 45 Gy {{#subobject:19c7tg|Variant=1}}===
 {| class="wikitable sortable" style="width: 100%; text-align:center;"
@@ Line 96: / Line 100: @@
 |}
 ''Note: Treatment starts on a Monday.''
+<div class="toccolours" style="background-color:#b3e2cd">
 ====Chemotherapy====
 *[[Capecitabine (Xeloda)]] 825 mg/m<sup>2</sup> PO twice per day on days 1 to 5
@@ Line 101: / Line 106: @@
 ====Radiotherapy====
 *Concurrent [[External_beam_radiotherapy|radiation therapy]], 45 Gy total in 25 fractions
 '''5-week course'''
+</div>
+<div class="toccolours" style="background-color:#cbd5e7">
 ====Subsequent treatment====
 *[[Surgery#Colorectal_cancer_surgery|Surgery]], then adjuvant [[#Capecitabine_monotherapy|capecitabine]]
+</div></div><br>
+<div class="toccolours" style="background-color:#eeeeee">
 ===Regimen variant #4, continuous capecitabine, 1650 mg/m<sup>2</sup>/day, 45 Gy {{#subobject:a05392|Variant=1}}===
 {| class="wikitable sortable" style="width: 100%; text-align:center;"
@@ Line 148: / Line 155: @@
 |-
 |}
+<div class="toccolours" style="background-color:#b3e2cd">
 ====Chemotherapy====
 *[[Capecitabine (Xeloda)]] 825 mg/m<sup>2</sup> PO twice per day on days 1 to 38
 ====Radiotherapy====
 *Concurrent [[External_beam_radiotherapy|radiation therapy]], 1.8 Gy for 25 fractions (45 Gy), with boost depending on stage
 '''5.5-week course'''
+</div>
+<div class="toccolours" style="background-color:#cbd5e7">
 ====Subsequent treatment====
 *[[Surgery#Colorectal_cancer_surgery|Surgery]], then adjuvant [[#Capecitabine_monotherapy|capecitabine]]
+</div></div><br>
+<div class="toccolours" style="background-color:#eeeeee">
 ===Regimen variant #5, interrupted capecitabine, 1650 mg/m<sup>2</sup>/day, 50 Gy {{#subobject:19ihaa|Variant=1}}===
 {| class="wikitable sortable" style="width: 100%; text-align:center;"
@@ Line 173: / Line 183: @@
 |}
 ''Note: Treatment is assumed to start on a Monday. Surgery is to take place 8 weeks after completion of chemoradiotherapy.''
+<div class="toccolours" style="background-color:#b3e2cd">
 ====Chemotherapy====
 *[[Capecitabine (Xeloda)]] 825 mg/m<sup>2</sup> PO twice per day on days 1 to 5
@@ Line 178: / Line 189: @@
 ====Radiotherapy====
 *Concurrent [[External_beam_radiotherapy|radiation therapy]], 50 Gy total in 25 fractions
 '''5-week course'''
+</div>
+<div class="toccolours" style="background-color:#cbd5e7">
 ====Subsequent treatment====
 *[[#CapeOx|CapeOx]] x 1, then [[Surgery#Colorectal_cancer_surgery|TME]], then [[#CapeOx|CapeOx]] x 5
+</div></div><br>
+<div class="toccolours" style="background-color:#eeeeee">
 ===Regimen variant #6, interrupted capecitabine, 1650 mg/m<sup>2</sup>/day, 50.4 Gy {{#subobject:17tatg|Variant=1}}===
 {| class="wikitable sortable" style="width: 100%; text-align:center;"
@@ Line 199: / Line 212: @@
 |}
 ''Note: Treatment starts on a Monday.''
+<div class="toccolours" style="background-color:#b3e2cd">
 ====Chemotherapy====
 *[[Capecitabine (Xeloda)]] 825 mg/m<sup>2</sup> PO twice per day on days 1 to 5
@@ Line 204: / Line 218: @@
 ====Radiotherapy====
 *Concurrent [[External_beam_radiotherapy|radiation therapy]], 50.4 Gy total in 28 fractions (1.8 Gy per fraction)
 '''5.5-week course'''
+</div>
+<div class="toccolours" style="background-color:#cbd5e7">
 ====Subsequent treatment====
 *[[Surgery#Colorectal_cancer_surgery|Surgery]], then adjuvant [[#Capecitabine_monotherapy|capecitabine]]
+</div></div>
 ===References===
 # '''ACCORD 12:''' Gérard JP, Azria D, Gourgou-Bourgade S, Martel-Laffay I, Hennequin C, Etienne PL, Vendrely V, François E, de La Roche G, Bouché O, Mirabel X, Denis B, Mineur L, Berdah JF, Mahé MA, Bécouarn Y, Dupuis O, Lledo G, Montoto-Grillot C, Conroy T. 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. 2010 Apr 1;28(10):1638-44. Epub 2010 Mar 1. [https://doi.org/10.1200/JCO.2009.25.8376 link to original article] '''contains dosing details in manuscript''' [https://pubmed.ncbi.nlm.nih.gov/20194850 PubMed] NCT00227747
@@ Line 221: / Line 236: @@
 # '''UNICANCER-PRODIGE 23:''' Conroy T, Bosset JF, Etienne PL, Rio E, François É, Mesgouez-Nebout N, Vendrely V, Artignan X, Bouché O, Gargot D, Boige V, Bonichon-Lamichhane N, Louvet C, Morand C, de la Fouchardière C, Lamfichekh N, Juzyna B, Jouffroy-Zeller C, Rullier E, Marchal F, Gourgou S, Castan F, Borg C; Unicancer Gastrointestinal Group and Partenariat de Recherche en Oncologie Digestive (PRODIGE) Group. Neoadjuvant chemotherapy with FOLFIRINOX and preoperative chemoradiotherapy for patients with locally advanced rectal cancer (UNICANCER-PRODIGE 23): a multicentre, randomised, open-label, phase 3 trial. Lancet Oncol. 2021 May;22(5):702-715. Epub 2021 Apr 13. [https://doi.org/10.1016/s1470-2045(21)00079-6 link to original article] '''contains dosing details in abstract''' [https://pubmed.ncbi.nlm.nih.gov/33862000/ PubMed] NCT01804790
 # '''STELLAR<sub>rectal</sub>:''' Jin J, Tang Y, Hu C, Jiang LM, Jiang J, Li N, Liu WY, Chen SL, Li S, Lu NN, Cai Y, Li YH, Zhu Y, Cheng GH, Zhang HY, Wang X, Zhu SY, Wang J, Li GF, Yang JL, Zhang K, Chi Y, Yang L, Zhou HT, Zhou AP, Zou SM, Fang H, Wang SL, Zhang HZ, Wang XS, Wei LC, Wang WL, Liu SX, Gao YH, Li YX. Multicenter, Randomized, Phase III Trial of Short-Term Radiotherapy Plus Chemotherapy Versus Long-Term Chemoradiotherapy in Locally Advanced Rectal Cancer (STELLAR). J Clin Oncol. 2022 May 20;40(15):1681-1692. Epub 2022 Mar 9. [https://doi.org/10.1200/jco.21.01667 link to original article] [https://www.ncbi.nlm.nih.gov/pmc/articles/pmc9113208/ link to PMC article] NCT02533271 [https://pubmed.ncbi.nlm.nih.gov/35263150/ PubMed]
 ==Capecitabine, Sorafenib, RT {{#subobject:1812b9|Regimen=1}}==
 Capecitabine, Sorafenib, RT: Capecitabine, Sorafenib, '''<u>R</u>'''adiation '''<u>T</u>'''herapy
+<div class="toccolours" style="background-color:#eeeeee">
 ===Regimen {{#subobject:a01232|Variant=1}}===
 {| class="wikitable" style="width: 40%; text-align:center;"
@@ Line 235: / Line 249: @@
 |}
 ''Note: this regimen was intended for KRAS-mutated rectal cancer.''
+<div class="toccolours" style="background-color:#b3e2cd">
 ====Chemotherapy====
 *[[Capecitabine (Xeloda)]] 825 mg/m<sup>2</sup> PO twice per day on days 1 to 33
@@ Line 241: / Line 256: @@
 ====Radiotherapy====
 *Concurrent [[External_beam_radiotherapy|radiation therapy]], 45 Gy total
 '''5-week course'''
+</div>
+<div class="toccolours" style="background-color:#cbd5e7">
 ====Subsequent treatment====
 *[[Surgery#Colorectal_cancer_surgery|Surgery]]
+</div></div>
 ===References===
 # '''SAKK 41/08:''' von Moos R, Koeberle D, Schacher S, Hayoz S, Winterhalder RC, Roth A, Bodoky G, Samaras P, Berger MD, Rauch D, Saletti P, Plasswilm L, Zwahlen D, Meier UR, Yan P, Izzo P, Klingbiel D, Bärtschi D, Zaugg K; Swiss Group for Clinical Cancer Research. Neoadjuvant radiotherapy combined with capecitabine and sorafenib in patients with advanced KRAS-mutated rectal cancer: A phase I/II trial (SAKK 41/08). Eur J Cancer. 2018 Jan;89:82-89. Epub 2017 Dec 11. [https://www.ejcancer.com/article/S0959-8049(17)31402-8 link to original article] [https://pubmed.ncbi.nlm.nih.gov/29241084 PubMed]
 ==CapeOx {{#subobject:cf9acc|Regimen=1}}==
 CapeOX: '''<u>Cape</u>'''citabine & '''<u>OX</u>'''aliplatin
+<div class="toccolours" style="background-color:#eeeeee">
 ===Regimen variant #1, 4 cycles {{#subobject:205ad6|Variant=1}}===
 {| class="wikitable sortable" style="width: 60%; text-align:center;"
@@ Line 262: / Line 278: @@
 |-
 |}
+<div class="toccolours" style="background-color:#b3e2cd">
 ====Chemotherapy====
 *[[Capecitabine (Xeloda)]] 1000 mg/m<sup>2</sup> PO twice per day on days 1 to 14
 *[[Oxaliplatin (Eloxatin)]] 130 mg/m<sup>2</sup> IV once on day 1
 '''21-day cycle for 4 cycles'''
+</div>
+<div class="toccolours" style="background-color:#cbd5e7">
 ====Subsequent treatment====
 *[[#Capecitabine_.26_RT|Capecitabine & RT]], then [[Surgery#Total_mesorectal_excision|TME]]
+</div></div><br>
+<div class="toccolours" style="background-color:#eeeeee">
 ===Regimen variant #2, 6 cycles {{#subobject:9a1iog|Variant=1}}===
 {| class="wikitable sortable" style="width: 100%; text-align:center;"
@@ Line 285: / Line 304: @@
 |-
 |}
+<div class="toccolours" style="background-color:#cbd5e8">
 ====Preceding treatment====
 *[[#Radiation_therapy|RT]]; 5 x 5 Gy
+</div>
+<div class="toccolours" style="background-color:#b3e2cd">
 ====Chemotherapy====
 *[[Capecitabine (Xeloda)]] 1000 mg/m<sup>2</sup> PO twice per day on days 1 to 14
 *[[Oxaliplatin (Eloxatin)]] 130 mg/m<sup>2</sup> IV once on day 1
 '''21-day cycle for 6 cycles'''
+</div>
+<div class="toccolours" style="background-color:#cbd5e7">
 ====Subsequent treatment====
 *[[Surgery#Total_mesorectal_excision|TME]]
+</div></div>
 ===References===
 # Chua YJ, Barbachano Y, Cunningham D, Oates JR, Brown G, Wotherspoon A, Tait D, Massey A, Tebbutt NC, Chau I. Neoadjuvant capecitabine and oxaliplatin before chemoradiotherapy and total mesorectal excision in MRI-defined poor-risk rectal cancer: a phase 2 trial. Lancet Oncol. 2010 Mar;11(3):241-8. Epub 2010 Jan 25. [https://doi.org/10.1016/s1470-2045(09)70381-x link to original article] '''contains dosing details in abstract''' [https://pubmed.ncbi.nlm.nih.gov/20106720 PubMed] NCT00220051
 #'''RAPIDO:''' Bahadoer RR, Dijkstra EA, van Etten B, Marijnen CAM, Putter H, Kranenbarg EM, Roodvoets AGH, Nagtegaal ID, Beets-Tan RGH, Blomqvist LK, Fokstuen T, Ten Tije AJ, Capdevila J, Hendriks MP, Edhemovic I, Cervantes A, Nilsson PJ, Glimelius B, van de Velde CJH, Hospers GAP; RAPIDO collaborative investigators. Short-course radiotherapy followed by chemotherapy before total mesorectal excision (TME) versus preoperative chemoradiotherapy, TME, and optional adjuvant chemotherapy in locally advanced rectal cancer (RAPIDO): a randomised, open-label, phase 3 trial. Lancet Oncol. 2021 Jan;22(1):29-42. Epub 2020 Dec 7. [https://doi.org/10.1016/s1470-2045(20)30555-6 link to original article] '''contains dosing details in manuscript''' [https://pubmed.ncbi.nlm.nih.gov/33301740 PubMed] NCT01558921
 ==CapeOx, Cetuximab, RT {{#subobject:2d68ed|Regimen=1}}==
 CapeOX, Cetuximab, RT: '''<u>Cape</u>'''citabine, '''<u>OX</u>'''aliplatin, Cetuximab, '''<u>R</u>'''adiation '''<u>T</u>'''herapy
+<div class="toccolours" style="background-color:#eeeeee">
 ===Regimen {{#subobject:5a3ef0|Variant=1}}===
 {| class="wikitable" style="width: 40%; text-align:center;"
@@ Line 312: / Line 333: @@
 |-
 |}
+<div class="toccolours" style="background-color:#b3e2cd">
 ====Chemotherapy====
 *[[Capecitabine (Xeloda)]] 825 mg/m<sup>2</sup> PO twice per day on Monday to Friday
@@ Line 324: / Line 346: @@
 ====Radiotherapy====
 *[[External_beam_radiotherapy|RT]] 180 cGy in 25 fractions, started with cycle 2
 '''5-week course'''
+</div>
+<div class="toccolours" style="background-color:#cbd5e7">
 ====Subsequent treatment====
 *[[Surgery#Total_mesorectal_excision|TME]]
+</div></div>
 ===References===
 # '''SWOG S0713:''' Leichman CG, McDonough SL, Smalley SR, Billingsley KG, Lenz HJ, Beldner MA, Hezel AF, Velasco MR, Guthrie KA, Blanke CD, Hochster HS. Cetuximab Combined With Induction Oxaliplatin and Capecitabine, Followed by Neoadjuvant Chemoradiation for Locally Advanced Rectal Cancer: SWOG 0713. Clin Colorectal Cancer. 2018 Mar;17(1):e121-e125. Epub 2017 Oct 24. [https://www.clinical-colorectal-cancer.com/article/S1533-0028(17)30061-0 link to original article] '''contains dosing details in manuscript''' [https://pubmed.ncbi.nlm.nih.gov/29233486 PubMed]
 ==CapIriRT {{#subobject:115th9|Regimen=1}}==
 CapIriRT: '''<u>Cap</u>'''ecitabine, '''<u>Iri</u>'''notecan, '''<u>R</u>'''adiation '''<u>T</u>'''herapy
+<div class="toccolours" style="background-color:#eeeeee">
 ===Regimen variant #1, 65 mg/m<sup>2</sup> {{#subobject:19ugak|Variant=1}}===
 {| class="wikitable sortable" style="width: 100%; text-align:center;"
@@ Line 351: / Line 373: @@
 |}
 ''Note: Treatment is assumed to start on a Monday. Surgery is to take place 8 weeks after completion of chemoradiotherapy.''
+<div class="toccolours" style="background-color:#fdcdac">
 ====Biomarker eligibility criteria====
 *''UGT1A1*1*28'' genotype
+</div>
+<div class="toccolours" style="background-color:#b3e2cd">
 ====Chemotherapy====
 *[[Capecitabine (Xeloda)]] 625 mg/m<sup>2</sup> PO twice per day on days 1 to 5
@@ Line 359: / Line 384: @@
 ====Radiotherapy====
 *Concurrent [[External_beam_radiotherapy|radiation therapy]], 50 Gy total in 25 fractions
 '''5-week course'''
+</div>
+<div class="toccolours" style="background-color:#cbd5e7">
 ====Subsequent treatment====
 *[[#CAPIRI_88|CAPIRI]] x 1, then [[Surgery#Colorectal_cancer_surgery|TME]], then [[#CapeOx|CapeOx]] x 5
+</div></div><br>
+<div class="toccolours" style="background-color:#eeeeee">
 ===Regimen variant #2, 80 mg/m<sup>2</sup> {{#subobject:t81bak|Variant=1}}===
 {| class="wikitable sortable" style="width: 100%; text-align:center;"
@@ Line 380: / Line 407: @@
 |}
 ''Note: Treatment is assumed to start on a Monday. Surgery is to take place 8 weeks after completion of chemoradiotherapy.''
+<div class="toccolours" style="background-color:#fdcdac">
 ====Biomarker eligibility criteria====
 *''UGT1A1*1*1'' genotype
+</div>
+<div class="toccolours" style="background-color:#b3e2cd">
 ====Chemotherapy====
 *[[Capecitabine (Xeloda)]] 625 mg/m<sup>2</sup> PO twice per day on days 1 to 5
@@ Line 388: / Line 418: @@
 ====Radiotherapy====
 *Concurrent [[External_beam_radiotherapy|radiation therapy]], 50 Gy total in 25 fractions
 '''5-week course'''
+</div>
+<div class="toccolours" style="background-color:#cbd5e7">
 ====Subsequent treatment====
 *[[#CAPIRI_88|CAPIRI]] x 1, then [[Surgery#Colorectal_cancer_surgery|TME]], then [[#CapeOx|CapeOx]] x 5
+</div></div>
 ===References===
 #'''CinClare:''' Zhu J, Liu A, Sun X, Liu L, Zhu Y, Zhang T, Jia J, Tan S, Wu J, Wang X, Zhou J, Yang J, Zhang C, Zhang H, Zhao Y, Cai G, Zhang W, Xia F, Wan J, Zhang H, Shen L, Cai S, Zhang Z. Multicenter, Randomized, Phase III Trial of Neoadjuvant Chemoradiation With Capecitabine and Irinotecan Guided by UGT1A1 Status in Patients With Locally Advanced Rectal Cancer. J Clin Oncol. 2020 Dec 20;38(36):4231-4239. Epub 2020 Oct 29. [https://doi.org/10.1200/jco.20.01932 link to original article] [https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7768334/ link to PMC article] '''contains dosing details in manuscript''' [https://pubmed.ncbi.nlm.nih.gov/33119477 PubMed] NCT02605265
 ==Fluorouracil & RT {{#subobject:bffc7f|Regimen=1}}==
 Fluorouracil & RT: Fluorouracil & '''<u>R</u>'''adiation '''<u>T</u>'''herapy
+<div class="toccolours" style="background-color:#eeeeee">
 ===Regimen variant #1, continuous {{#subobject:5801b6|Variant=1}}===
 {| class="wikitable sortable" style="width: 100%; text-align:center;"
@@ Line 434: / Line 465: @@
 |}
 ''<sup>1</sup>Reported efficacy for STAR-01 is based on the 2016 update.''
+<div class="toccolours" style="background-color:#b3e2cd">
 ====Chemotherapy====
 *[[Fluorouracil (5-FU)]] 225 mg/m<sup>2</sup>/day IV continuous infusion until the end of radiation, started on day 1
 ====Radiotherapy====
 *Concurrent [[External_beam_radiotherapy|radiation therapy]], 1.8 Gy for 25 fractions (45 Gy), with boost depending on stage
 '''5-week course'''
+</div>
+<div class="toccolours" style="background-color:#cbd5e7">
 ====Subsequent treatment====
 *STAR-01: [[Surgery#Colorectal_cancer_surgery|Surgery]], preferably [[Surgery#Total_mesorectal_excision|TME]], then adjuvant [[Regimen_classes#5-FU-based_regimen|fluourouracil-based therapy]]
 *NSABP R-04: [[Surgery#Colorectal_cancer_surgery|Surgery]]
+</div></div><br>
+<div class="toccolours" style="background-color:#eeeeee">
 ===Regimen variant #2, intermittent {{#subobject:3c5452|Variant=1}}===
 {| class="wikitable sortable" style="width: 100%; text-align:center;"
@@ Line 471: / Line 505: @@
 |-
 |}
+<div class="toccolours" style="background-color:#b3e2cd">
 ====Chemotherapy====
 *[[Fluorouracil (5-FU)]] 1000 mg/m<sup>2</sup>/day IV continuous infusion over 120 hours, started on day 1 (total dose per cycle: 5000 mg/m<sup>2</sup>)
@@ Line 476: / Line 511: @@
 ====Radiotherapy====
 *Concurrent [[External_beam_radiotherapy|radiation therapy]], 50.4 Gy total
 '''One course'''
+</div>
+<div class="toccolours" style="background-color:#cbd5e7">
 ====Subsequent treatment====
 *CAO/ARO/AIO-94: [[Surgery#Total_mesorectal_excision|TME]], then adjuvant [[#Fluorouracil_monotherapy|5-FU]]
+</div></div>
 ===References===
 # '''CAO/ARO/AIO-94:''' Sauer R, Becker H, Hohenberger W, Rödel C, Wittekind C, Fietkau R, Martus P, Tschmelitsch J, Hager E, Hess CF, Karstens JH, Liersch T, Schmidberger H, Raab R; German Rectal Cancer Study Group. Preoperative versus postoperative chemoradiotherapy for rectal cancer. N Engl J Med. 2004 Oct 21;351(17):1731-40. [https://doi.org/10.1056/NEJMoa040694 link to original article] '''contains dosing details in manuscript''' [https://pubmed.ncbi.nlm.nih.gov/15496622 PubMed]
@@ Line 492: / Line 528: @@
 # '''NSABP R-04:''' O'Connell MJ, Colangelo LH, Beart RW, Petrelli NJ, Allegra CJ, Sharif S, Pitot HC, Shields AF, Landry JC, Ryan DP, Parda DS, Mohiuddin M, Arora A, Evans LS, Bahary N, Soori GS, Eakle J, Robertson JM, Moore DF Jr, Mullane MR, Marchello BT, Ward PJ, Wozniak TF, Roh MS, Yothers G, Wolmark N. 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. 2014 Jun 20;32(18):1927-34. Epub 2014 May 5. [https://doi.org/10.1200/JCO.2013.53.7753 link to original article] [https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4050205/ link to PMC article] '''contains dosing details in manuscript''' [https://pubmed.ncbi.nlm.nih.gov/24799484 PubMed] NCT00058474
 ## '''Update:''' Allegra CJ, Yothers G, O'Connell MJ, Beart RW, Wozniak TF, Pitot HC, Shields AF, Landry JC, Ryan DP, Arora A, Evans LS, Bahary N, Soori G, Eakle JF, Robertson JM, Moore DF Jr, Mullane MR, Marchello BT, Ward PJ, Sharif S, Roh MS, Wolmark N. Neoadjuvant 5-FU or capecitabine plus radiation with or without oxaliplatin in rectal cancer patients: a phase III randomized clinical trial. J Natl Cancer Inst. 2015 Sep 14;107(11). Erratum in: J Natl Cancer Inst. 2016 Apr;108(4). [https://academic.oup.com/jnci/article/107/11/djv248/2457689 link to original article] [https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4849360/ link to PMC article] [https://pubmed.ncbi.nlm.nih.gov/26374429 PubMed]
 ==FOLFIRINOX {{#subobject:aaa3c4|Regimen=1}}==
 FOLFIRINOX: '''<u>FOL</u>'''inic acid, '''<u>F</u>'''luorouracil, '''<u>IRIN</u>'''otecan, '''<u>OX</u>'''aliplatin
+<div class="toccolours" style="background-color:#eeeeee">
 ===Regimen {{#subobject:e140cb|Variant=1}}===
 {| class="wikitable sortable" style="width: 100%; text-align:center;"
@@ Line 511: / Line 546: @@
 |-
 |}
+<div class="toccolours" style="background-color:#b3e2cd">
 ====Chemotherapy====
 *[[Folinic acid (Leucovorin)]] 400 mg/m<sup>2</sup> IV once on day 1
 *[[Fluorouracil (5-FU)]] 2400 mg/m<sup>2</sup> IV continuous infusion (duration not specified)
 *[[Irinotecan (Camptosar)]] 180 mg/m<sup>2</sup> IV once on day 1
 *[[Oxaliplatin (Eloxatin)]] 85 mg/m<sup>2</sup> IV once on day 1
 '''14-day cycle for 6 cycles'''
+</div>
+<div class="toccolours" style="background-color:#cbd5e7">
 ====Subsequent treatment====
 *[[#Capecitabine_.26_RT|Capecitabine & RT]]
+</div></div>
 ===References===
 # '''UNICANCER-PRODIGE 23:''' Conroy T, Bosset JF, Etienne PL, Rio E, François É, Mesgouez-Nebout N, Vendrely V, Artignan X, Bouché O, Gargot D, Boige V, Bonichon-Lamichhane N, Louvet C, Morand C, de la Fouchardière C, Lamfichekh N, Juzyna B, Jouffroy-Zeller C, Rullier E, Marchal F, Gourgou S, Castan F, Borg C; Unicancer Gastrointestinal Group and Partenariat de Recherche en Oncologie Digestive (PRODIGE) Group. Neoadjuvant chemotherapy with FOLFIRINOX and preoperative chemoradiotherapy for patients with locally advanced rectal cancer (UNICANCER-PRODIGE 23): a multicentre, randomised, open-label, phase 3 trial. Lancet Oncol. 2021 May;22(5):702-715. Epub 2021 Apr 13. [https://doi.org/10.1016/s1470-2045(21)00079-6 link to original article] '''contains dosing details in abstract''' [https://pubmed.ncbi.nlm.nih.gov/33862000/ PubMed] NCT01804790
 ==FULV & RT {{#subobject:fbe1a7|Regimen=1}}==
 FULV & RT: '''<u>F</u>'''luoro'''<u>U</u>'''racil, '''<u>L</u>'''euco'''<u>V</u>'''orin (Folinic acid) & '''<u>R</u>'''adiation '''<u>T</u>'''herapy
+<div class="toccolours" style="background-color:#eeeeee">
 ===Regimen variant #1, 800/200 ("Nordic schedule") {{#subobject:3780c0|Variant=1}}===
 {| class="wikitable sortable" style="width: 100%; text-align:center;"
@@ Line 543: / Line 579: @@
 |}
 ''Note: reported efficacy is based on the 2018 update.''
+<div class="toccolours" style="background-color:#b3e2cd">
 ====Chemotherapy====
 *[[Fluorouracil (5-FU)]] 400 mg/m<sup>2</sup> IV once per day on days 1 & 2, '''given first, prior to RT'''
@@ Line 550: / Line 587: @@
 *Concurrent [[External_beam_radiotherapy|radiation therapy]], 2 Gy x 25 fractions (total of 50 Gy)
 '''5-week course'''
+</div>
+<div class="toccolours" style="background-color:#cbd5e7">
 ====Subsequent treatment====
 *[[Surgery#Colorectal_cancer_surgery|Surgery]], then [[#FULV|FULV]] x 8
+</div></div><br>
+<div class="toccolours" style="background-color:#eeeeee">
 ===Regimen variant #2, 1625/100 {{#subobject:0160e1|Variant=1}}===
 {| class="wikitable sortable" style="width: 100%; text-align:center;"
@@ Line 568: / Line 608: @@
 |-
 |}
+<div class="toccolours" style="background-color:#cbd5e8">
 ====Preceding treatment====
 *[[#FULV_88|FULV]] x 1
+</div>
+<div class="toccolours" style="background-color:#b3e2cd">
 ====Chemotherapy====
 *[[Fluorouracil (5-FU)]] 325 mg/m<sup>2</sup> IV once per day on days 1 to 5
@@ Line 577: / Line 620: @@
 *Concurrent [[External_beam_radiotherapy|radiation therapy]], 50.4 Gy
 '''5-week course'''
+</div>
+<div class="toccolours" style="background-color:#cbd5e7">
 ====Subsequent treatment====
 *[[Surgery#Colorectal_cancer_surgery|Surgery]], then [[#FULV|FULV]] x 4
+</div></div><br>
+<div class="toccolours" style="background-color:#eeeeee">
 ===Regimen variant #3, 1750/100 {{#subobject:7d3ec1|Variant=1}}===
 {| class="wikitable sortable" style="width: 100%; text-align:center;"
@@ Line 609: / Line 654: @@
 |}
 ''<sup>1</sup>These trials were negative for the primary endpoint of overall survival, but had much improved local control for the experimental arm.''
+<div class="toccolours" style="background-color:#b3e2cd">
 ====Chemotherapy====
 *[[Fluorouracil (5-FU)]] 350 mg/m<sup>2</sup> IV once per day on days 1 to 5
@@ Line 616: / Line 662: @@
 *Concurrent [[External_beam_radiotherapy|radiation therapy]], 45 Gy
 '''5-week course'''
+</div>
+<div class="toccolours" style="background-color:#cbd5e7">
 ====Subsequent treatment====
 *FFCD 9203 & EORTC 22921: [[Surgery#Colorectal_cancer_surgery|Surgery]], then adjuvant [[#FULV|FULV]] x 2
 *I-CNR-RT: [[Surgery#Colorectal_cancer_surgery|Surgery]], then adjuvant [[#FULV|FULV]] versus [[Rectal_cancer_-_null_regimens#Observation|no further treatment]]
+</div></div><br>
+<div class="toccolours" style="background-color:#eeeeee">
 ===Regimen variant #4, 2800/400 {{#subobject:98d3ca|Variant=1}}===
 {| class="wikitable sortable" style="width: 100%; text-align:center;"
@@ Line 641: / Line 689: @@
 ''<sup>1</sup>Reported efficacy is based on the 2019 update.''<br>
 ''Note: this regimen is stated to be based on the de Gramont regimen in the manuscript, although the details are different than those in de Gramont et al. 2000.''
+<div class="toccolours" style="background-color:#b3e2cd">
 ====Chemotherapy====
 *[[Fluorouracil (5-FU)]] 400 mg/m<sup>2</sup> IV bolus once on day 1, then 1200 mg/m<sup>2</sup>/day IV continuous infusion over 48 hours (total dose per cycle: 2800 mg/m<sup>2</sup>)
@@ Line 647: / Line 696: @@
 ====Radiotherapy====
 *Concurrent [[External_beam_radiotherapy|radiation therapy]] given during cycles 2 to 4: 1.8 to 2 Gy once per day Monday through Friday for a total of 23 to 28 fractions over 5 to 6 weeks and a total dose of 46 to 50.4 Gy
 '''6-week course'''
+</div>
+<div class="toccolours" style="background-color:#cbd5e7">
 ====Subsequent treatment====
 *[[Surgery#Colorectal_cancer_surgery|Surgery]], then adjuvant [[#FULV|FULV]] x 7
+</div></div>
 ===References===
 # '''FFCD 9203:''' Gérard JP, Conroy T, Bonnetain F, Bouché O, Chapet O, Closon-Dejardin MT, Untereiner M, Leduc B, Francois E, Maurel J, Seitz JF, Buecher B, Mackiewicz R, Ducreux M, Bedenne L. Preoperative radiotherapy with or without concurrent fluorouracil and leucovorin in T3-4 rectal cancers: results of FFCD 9203. J Clin Oncol. 2006 Oct 1;24(28):4620-5. [https://doi.org/10.1200/JCO.2006.06.7629 link to original article] '''contains dosing details in manuscript''' [https://pubmed.ncbi.nlm.nih.gov/17008704 PubMed] NCT00296608
@@ Line 664: / Line 713: @@
 # '''FOWARC:''' Deng Y, Chi P, Lan P, Wang L, Chen W, Cui L, Chen D, Cao J, Wei H, Peng X, Huang Z, Cai G, Zhao R, Huang Z, Xu L, Zhou H, Wei Y, Zhang H, Zheng J, Huang Y, Zhou Z, Cai Y, Kang L, Huang M, Peng J, Ren D, Wang J. Modified FOLFOX6 with or without radiation versus fluorouracil and leucovorin with radiation in neoadjuvant treatment of locally advanced rectal cancer: initial results of the Chinese FOWARC multicenter, open-label, randomized three-arm phase III trial. J Clin Oncol. 2016 Sep 20;34(27):3300-7. Epub 2016 Aug 1. [https://doi.org/10.1200/jco.2016.66.6198 link to original article] '''contains dosing details in manuscript''' [https://pubmed.ncbi.nlm.nih.gov/27480145 PubMed] NCT01211210
 ## '''Update:''' Deng Y, Chi P, Lan P, Wang L, Chen W, Cui L, Chen D, Cao J, Wei H, Peng X, Huang Z, Cai G, Zhao R, Huang Z, Xu L, Zhou H, Wei Y, Zhang H, Zheng J, Huang Y, Zhou Z, Cai Y, Kang L, Huang M, Wu X, Peng J, Ren D, Wang J. Neoadjuvant Modified FOLFOX6 With or Without Radiation Versus Fluorouracil Plus Radiation for Locally Advanced Rectal Cancer: Final Results of the Chinese FOWARC Trial. J Clin Oncol. 2019 Dec 1;37(34):3223-3233. Epub 2019 Sep 26. [https://doi.org/10.1200/JCO.18.02309 link to original article] [https://pubmed.ncbi.nlm.nih.gov/31557064 PubMed]
 ==FUOX & RT {{#subobject:b3761c|Regimen=1}}==
 FUOX & RT: '''<u>F</u>'''luoro'''<u>U</u>'''racil, '''<u>OX</u>'''aliplatin, '''<u>R</u>'''adiation '''<u>T</u>'''herapy
+<div class="toccolours" style="background-color:#eeeeee">
 ===Regimen variant #1, 225/50 {{#subobject:66269c|Variant=1}}===
 {| class="wikitable sortable" style="width: 100%; text-align:center;"
@@ Line 690: / Line 738: @@
 |}
 ''Note: this is an experimental arm that did not meet its primary endpoint; included here because other variants of this regimen have demonstrated comparative superiority.''
+<div class="toccolours" style="background-color:#b3e2cd">
 ====Chemotherapy====
 *[[Fluorouracil (5-FU)]] 225 mg/m<sup>2</sup>/day IV continuous infusion over 120 hours, started on day 1 (total dose per cycle: 1125 mg/m<sup>2</sup>)
@@ Line 696: / Line 745: @@
 ====Radiotherapy====
 *Concurrent [[External_beam_radiotherapy|radiation therapy]], 50.4 Gy total
 '''5.5-week course'''
+</div>
+<div class="toccolours" style="background-color:#cbd5e7">
 ====Subsequent treatment====
 *[[Surgery#Colorectal_cancer_surgery|Surgery]]
+</div></div><br>
+<div class="toccolours" style="background-color:#eeeeee">
 ===Regimen variant #2, 225/60 {{#subobject:0b1c02|Variant=1}}===
 {| class="wikitable sortable" style="width: 100%; text-align:center;"
@@ Line 720: / Line 770: @@
 |}
 ''<sup>1</sup>Reported efficacy is based on the 2016 update.''<br>
-''This is an experimental arm that did not meet its primary endpoint; included here because other variants of this regimen have demonstrated comparative superiority.''
+''Note: This is an experimental arm that did not meet its primary endpoint; included here because other variants of this regimen have demonstrated comparative superiority.''
+<div class="toccolours" style="background-color:#b3e2cd">
 ====Chemotherapy====
 *[[Fluorouracil (5-FU)]] 225 mg/m<sup>2</sup>/day IV continuous infusion over approximately 6 weeks, started on day 1
@@ Line 726: / Line 777: @@
 ====Radiotherapy====
 *Concurrent [[External_beam_radiotherapy|radiation therapy]], 50.4 Gy total
 '''6-week course'''
+</div>
+<div class="toccolours" style="background-color:#cbd5e7">
 ====Subsequent treatment====
 *[[Surgery#Colorectal_cancer_surgery|Surgery]], preferably [[Surgery#Total_mesorectal_excision|TME]], then adjuvant [[Regimen_classes#5-FU-based_regimen|fluourouracil-based therapy]]
+</div></div><br>
+<div class="toccolours" style="background-color:#eeeeee">
 ===Regimen variant #3, 250/50 {{#subobject:858489|Variant=1}}===
 {| class="wikitable sortable" style="width: 100%; text-align:center;"
@@ Line 746: / Line 799: @@
 |-
 |}
+<div class="toccolours" style="background-color:#b3e2cd">
 ====Chemotherapy====
 *[[Fluorouracil (5-FU)]] 250 mg/m<sup>2</sup>/day IV continuous infusion over 14 days, started on day 1 (total dose per cycle: 3500 mg/m<sup>2</sup>)
@@ Line 753: / Line 807: @@
 *Concurrent [[External_beam_radiotherapy|radiation therapy]], 50.4 Gy total
 '''One course'''
+</div>
+<div class="toccolours" style="background-color:#cbd5e7">
 ====Subsequent treatment====
 *[[Surgery#Colorectal_cancer_surgery|Surgery]], then adjuvant [[#FOLFOX|FOLFOX]]
+</div></div>
 ===References===
 # '''STAR-01:''' Aschele C, Cionini L, Lonardi S, Pinto C, Cordio S, Rosati G, Artale S, Tagliagambe A, Ambrosini G, Rosetti P, Bonetti A, Negru ME, Tronconi MC, Luppi G, Silvano G, Corsi DC, Bochicchio AM, Chiaulon G, Gallo M, Boni L. 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. 2011 Jul 10;29(20):2773-80. Epub 2011 May 23. [https://doi.org/10.1200/JCO.2010.34.4911 link to original article] '''contains dosing details in manuscript''' [https://pubmed.ncbi.nlm.nih.gov/21606427 PubMed]
@@ Line 764: / Line 819: @@
 # '''NSABP R-04:''' O'Connell MJ, Colangelo LH, Beart RW, Petrelli NJ, Allegra CJ, Sharif S, Pitot HC, Shields AF, Landry JC, Ryan DP, Parda DS, Mohiuddin M, Arora A, Evans LS, Bahary N, Soori GS, Eakle J, Robertson JM, Moore DF Jr, Mullane MR, Marchello BT, Ward PJ, Wozniak TF, Roh MS, Yothers G, Wolmark N. 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. 2014 Jun 20;32(18):1927-34. Epub 2014 May 5. [https://doi.org/10.1200/JCO.2013.53.7753 link to original article] [https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4050205/ link to PMC article] '''contains dosing details in manuscript''' [https://pubmed.ncbi.nlm.nih.gov/24799484 PubMed] NCT00058474
 ## '''Update:''' Allegra CJ, Yothers G, O'Connell MJ, Beart RW, Wozniak TF, Pitot HC, Shields AF, Landry JC, Ryan DP, Arora A, Evans LS, Bahary N, Soori G, Eakle JF, Robertson JM, Moore DF Jr, Mullane MR, Marchello BT, Ward PJ, Sharif S, Roh MS, Wolmark N. Neoadjuvant 5-FU or capecitabine plus radiation with or without oxaliplatin in rectal cancer patients: a phase III randomized clinical trial. J Natl Cancer Inst. 2015 Sep 14;107(11). Erratum in: J Natl Cancer Inst. 2016 Apr;108(4). [https://academic.oup.com/jnci/article/107/11/djv248/2457689 link to original article] [https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4849360/ link to PMC article] [https://pubmed.ncbi.nlm.nih.gov/26374429 PubMed]
 ==mFOLFOX6 & RT {{#subobject:4ffffc|Regimen=1}}==
 mFOLFOX6 & RT: '''<u>m</u>'''odified '''<u>FOL</u>'''inic acid, '''<u>F</u>'''luorouracil, '''<u>OX</u>'''aliplatin and '''<u>R</u>'''adiation '''<u>T</u>'''herapy
+<div class="toccolours" style="background-color:#eeeeee">
 ===Regimen {{#subobject:9bf2ab|Variant=1}}===
 {| class="wikitable sortable" style="width: 100%; text-align:center;"
@@ Line 787: / Line 841: @@
 |}
 ''<sup>1</sup>Reported efficacy is based on the 2019 update.''
+<div class="toccolours" style="background-color:#b3e2cd">
 ====Chemotherapy====
 *[[Folinic acid (Leucovorin)]] 400 mg/m<sup>2</sup> IV once on day 1
@@ Line 795: / Line 850: @@
 *Concurrent [[External_beam_radiotherapy|radiation therapy]] given before or after surgery at physician discretion: 1.8 to 2 Gy once per day Monday through Friday for a total of 23 to 28 fractions, for a total dose of 46 to 50.4 Gy
 '''5- to 6-week course'''
+</div>
+<div class="toccolours" style="background-color:#cbd5e7">
 ====Subsequent treatment====
 *[[Surgery#Colorectal_cancer_surgery|Surgery]], then 6 to 8 more cycles of [[#mFOLFOX6_88|mFOLFOX6]]
+</div></div>
 ===References===
 <!-- Presented at the 51st Annual Meeting of the American Society of Clinical Oncology, Chicago, IL, May 29-June 2, 2015, and 18th Annual Meeting of the Chinese Society of Clinical Oncology, Xiamen, China, September 16-20, 2015. -->
 # '''FOWARC:''' Deng Y, Chi P, Lan P, Wang L, Chen W, Cui L, Chen D, Cao J, Wei H, Peng X, Huang Z, Cai G, Zhao R, Huang Z, Xu L, Zhou H, Wei Y, Zhang H, Zheng J, Huang Y, Zhou Z, Cai Y, Kang L, Huang M, Peng J, Ren D, Wang J. Modified FOLFOX6 with or without radiation versus fluorouracil and leucovorin with radiation in neoadjuvant treatment of locally advanced rectal cancer: initial results of the Chinese FOWARC multicenter, open-label, randomized three-arm phase III trial. J Clin Oncol. 2016 Sep 20;34(27):3300-7. Epub 2016 Aug 1. [https://doi.org/10.1200/jco.2016.66.6198 link to original article] '''contains dosing details in manuscript''' [https://pubmed.ncbi.nlm.nih.gov/27480145 PubMed] NCT01211210
 ## '''Update:''' Deng Y, Chi P, Lan P, Wang L, Chen W, Cui L, Chen D, Cao J, Wei H, Peng X, Huang Z, Cai G, Zhao R, Huang Z, Xu L, Zhou H, Wei Y, Zhang H, Zheng J, Huang Y, Zhou Z, Cai Y, Kang L, Huang M, Wu X, Peng J, Ren D, Wang J. Neoadjuvant Modified FOLFOX6 With or Without Radiation Versus Fluorouracil Plus Radiation for Locally Advanced Rectal Cancer: Final Results of the Chinese FOWARC Trial. J Clin Oncol. 2019 Dec 1;37(34):3223-3233. Epub 2019 Sep 26. [https://doi.org/10.1200/JCO.18.02309 link to original article] [https://pubmed.ncbi.nlm.nih.gov/31557064 PubMed]
 ==Radiation therapy {{#subobject:41234c|Regimen=1}}==
 RT: '''<u>R</u>'''adiation '''<u>T</u>'''herapy
+<div class="toccolours" style="background-color:#eeeeee">
 ===Regimen variant #1, 25 Gy {{#subobject:9abcab|Variant=1}}===
 {| class="wikitable sortable" style="width: 100%; text-align:center;"
@@ Line 845: / Line 901: @@
 |-
 |}
+<div class="toccolours" style="background-color:#b3e2cd">
 ====Radiotherapy====
 *[[External_beam_radiotherapy|Radiation therapy]], 5 Gy once per day for a total of 5 fractions (total dose: 25 Gy)
 '''5-day course'''
+</div>
+<div class="toccolours" style="background-color:#cbd5e7">
 ====Subsequent treatment====
 *Swedish Rectal Cancer Trial, Kapiteijn et al. 2001, NCIC-CTG CO.16: [[Surgery#Colorectal_cancer_surgery|Surgery]]
 *Polish II: FOLFOX4 x 3, then [[Surgery#Colorectal_cancer_surgery|Surgery]]
 *RAPIDO: [[#CapeOx|CapeOx]] x 6 or FOLFOX4 x 9, then [[Surgery#Colorectal_cancer_surgery|Surgery]]
+</div></div><br>
+<div class="toccolours" style="background-color:#eeeeee">
 ===Regimen variant #2, 40 Gy {{#subobject:8b0799|Variant=1}}===
 {| class="wikitable sortable" style="width: 100%; text-align:center;"
@@ Line 869: / Line 928: @@
 |-
 |}
-''Of historic interest.''
+''Note: This variant is of historic interest.''
+<div class="toccolours" style="background-color:#b3e2cd">
 ====Radiotherapy====
 *[[External_beam_radiotherapy|Radiation therapy]], 2 Gy x 20 fractions (total dose: 40 Gy)
 '''4-week course'''
+</div>
+<div class="toccolours" style="background-color:#cbd5e7">
 ====Subsequent treatment====
 *[[Surgery#Colorectal_cancer_surgery|Surgery]]
+</div></div><br>
+<div class="toccolours" style="background-color:#eeeeee">
 ===Regimen variant #3, 50 Gy {{#subobject:159853|Variant=1}}===
 {| class="wikitable sortable" style="width: 100%; text-align:center;"
@@ Line 892: / Line 954: @@
 |-
 |}
-''Of historic interest.''
+''Note: this variant is of historic interest.''
+<div class="toccolours" style="background-color:#b3e2cd">
 ====Radiotherapy====
 *[[External_beam_radiotherapy|Radiation therapy]], 2 Gy x 25 fractions (total dose: 50 Gy)
 '''5-week course'''
+</div>
+<div class="toccolours" style="background-color:#cbd5e7">
 ====Subsequent treatment====
 *[[Surgery#Colorectal_cancer_surgery|Surgery]]
+</div></div>
 ===References===
 # Oates GD, Stenning SP, Hardcastle JD; Medical Research Council Rectal Cancer Working Party. Randomised trial of surgery alone versus radiotherapy followed by surgery for potentially operable locally advanced rectal cancer. Lancet. 1996 Dec 14;348(9042):1605-10. [https://doi.org/10.1016/S0140-6736(96)05348-2 link to original article] '''contains dosing details in abstract''' [https://pubmed.ncbi.nlm.nih.gov/8961989 PubMed]
@@ Line 910: / Line 975: @@
 ## '''Update:''' Ciseł B, Pietrzak L, Michalski W, Wyrwicz L, Rutkowski A, Kosakowska E, Cencelewicz A, Spałek M, Polkowski W, Jankiewicz M, Styliński R, Bębenek M, Kapturkiewicz B, Maciejczyk A, Sadowski J, Zygulska J, Zegarski W, Jankowski M, Las-Jankowska M, Toczko Z, Żelazowska-Omiotek U, Kępka L, Socha J, Wasilewska-Tesluk E, Markiewicz W, Kładny J, Majewski A, Kapuściński W, Suwiński R, Bujko K; Polish Colorectal Study Group. Long-course preoperative chemoradiation vs 5 x 5 Gy and consolidation chemotherapy for clinical T4 and fixed clinical T3 rectal cancer: long-term results of the randomized Polish II study. Ann Oncol. 2019 Aug 1;30(8):1298-1303. Epub 2019 Jun 13.  [https://doi.org/10.1093/annonc/mdz186 link to original article] [https://pubmed.ncbi.nlm.nih.gov/31192355 PubMed]
 #'''RAPIDO:''' Bahadoer RR, Dijkstra EA, van Etten B, Marijnen CAM, Putter H, Kranenbarg EM, Roodvoets AGH, Nagtegaal ID, Beets-Tan RGH, Blomqvist LK, Fokstuen T, Ten Tije AJ, Capdevila J, Hendriks MP, Edhemovic I, Cervantes A, Nilsson PJ, Glimelius B, van de Velde CJH, Hospers GAP; RAPIDO collaborative investigators. Short-course radiotherapy followed by chemotherapy before total mesorectal excision (TME) versus preoperative chemoradiotherapy, TME, and optional adjuvant chemotherapy in locally advanced rectal cancer (RAPIDO): a randomised, open-label, phase 3 trial. Lancet Oncol. 2021 Jan;22(1):29-42. Epub 2020 Dec 7. [https://doi.org/10.1016/s1470-2045(20)30555-6 link to original article] '''contains dosing details in manuscript''' [https://pubmed.ncbi.nlm.nih.gov/33301740 PubMed] NCT01558921
 =Adjuvant chemotherapy=
 ==Capecitabine monotherapy {{#subobject:38d595|Regimen=1}}==
+<div class="toccolours" style="background-color:#eeeeee">
 ===Regimen variant #1, 2000 mg/m<sup>2</sup>/day x 6 {{#subobject:48gua4|Variant=1}}===
 {| class="wikitable sortable" style="width: 100%; text-align:center;"
@@ Line 930: / Line 994: @@
 |}
 ''Note: this is a component of a sequential treatment protocol; to our knowledge there are no references to support using it as a stand-alone treatment.''
+<div class="toccolours" style="background-color:#cbd5e8">
 ====Preceding treatment====
 *[[#Capecitabine_.26_RT|Neoadjuvant capecitabine & RT]], then [[Surgery#Colorectal_cancer_surgery|surgery]]
+</div>
+<div class="toccolours" style="background-color:#b3e2cd">
 ====Chemotherapy====
 *[[Capecitabine (Xeloda)]] 1000 mg/m<sup>2</sup> PO twice per day on days 1 to 15
 '''21-day cycle for 6 cycles'''
+</div></div><br>
+<div class="toccolours" style="background-color:#eeeeee">
 ===Regimen variant #2, 2500 mg/m<sup>2</sup>/day x 5 {{#subobject:4e5ce4|Variant=1}}===
 {| class="wikitable sortable" style="width: 100%; text-align:center;"
@@ Line 953: / Line 1,020: @@
 |}
 ''Note: this is a component of a sequential treatment protocol; to our knowledge there are no references to support using it as a stand-alone treatment.''
+<div class="toccolours" style="background-color:#cbd5e8">
 ====Preceding treatment====
 *[[#Capecitabine_.26_RT|Neoadjuvant capecitabine & RT]], then [[Surgery#Colorectal_cancer_surgery|surgery]]
+</div>
+<div class="toccolours" style="background-color:#b3e2cd">
 ====Chemotherapy====
 *[[Capecitabine (Xeloda)]] 1250 mg/m<sup>2</sup> PO twice per day on days 1 to 14
 '''21-day cycle for 5 cycles'''
+</div></div><br>
+<div class="toccolours" style="background-color:#eeeeee">
 ===Regimen variant #3, 2500 mg/m<sup>2</sup>/day x 8 {{#subobject:4e9jn4|Variant=1}}===
 {| class="wikitable sortable" style="width: 100%; text-align:center;"
@@ Line 976: / Line 1,046: @@
 |}
 ''Note: this is a component of a sequential treatment protocol; to our knowledge there are no references to support using it as a stand-alone treatment.''
+<div class="toccolours" style="background-color:#cbd5e8">
 ====Preceding treatment====
 *[[Regimen_classes#5-FU-based_chemoradiotherapy|5-FU-based chemoradiotherapy]] or [[#Radiation_therapy|RT]], then [[Surgery#Colorectal_cancer_surgery|surgery]]
+</div>
+<div class="toccolours" style="background-color:#b3e2cd">
 ====Chemotherapy====
 *[[Capecitabine (Xeloda)]] 1250 mg/m<sup>2</sup> PO twice per day on days 1 to 14
 '''21-day cycle for 8 cycles'''
+</div></div>
 ===References===
 # '''Rektum-III:''' Hofheinz RD, Wenz F, Post S, Matzdorff A, Laechelt S, Hartmann JT, Müller L, Link H, Moehler M, Kettner E, Fritz E, Hieber U, Lindemann HW, Grunewald M, Kremers S, Constantin C, Hipp M, Hartung G, Gencer D, Kienle P, Burkholder I, Hochhaus A. Chemoradiotherapy with capecitabine versus fluorouracil for locally advanced rectal cancer: a randomised, multicentre, non-inferiority, phase 3 trial. Lancet Oncol. 2012 Jun;13(6):579-88. Epub 2012 Apr 12. [https://doi.org/10.1016/S1470-2045%2812%2970116-X link to original article] '''contains dosing details in manuscript''' [https://pubmed.ncbi.nlm.nih.gov/22503032 PubMed] NCT01500993
 # '''SCRIPT:''' Breugom AJ, van Gijn W, Muller EW, Berglund Å, van den Broek CB, Fokstuen T, Gelderblom H, Kapiteijn E, Leer JW, Marijnen CA, Martijn H, Meershoek-Klein Kranenbarg E, Nagtegaal ID, Påhlman L, Punt CJ, Putter H, Roodvoets AG, Rutten HJ, Steup WH, Glimelius B, van de Velde CJ; Dutch Colorectal Cancer Group; Nordic Gastrointestinal Tumour Adjuvant Therapy Group. Adjuvant chemotherapy for rectal cancer patients treated with preoperative (chemo)radiotherapy and total mesorectal excision: a Dutch Colorectal Cancer Group (DCCG) randomized phase III trial. Ann Oncol. 2015 Apr;26(4):696-701. Epub 2014 Dec 5. [https://doi.org/10.1093/annonc/mdu560 link to original article] '''contains dosing details in manuscript''' [https://pubmed.ncbi.nlm.nih.gov/25480874 PubMed] ISRCTN36266738
 # '''PETACC 6:''' Schmoll HJ, Stein A, Van Cutsem E, Price T, Hofheinz RD, Nordlinger B, Daisne JF, Janssens J, Brenner B, Reinel H, Hollerbach S, Caca K, Fauth F, Hannig CV, Zalcberg J, Tebbutt N, Mauer ME, Marreaud S, Lutz MP, Haustermans K. Pre- and Postoperative Capecitabine Without or With Oxaliplatin in Locally Advanced Rectal Cancer: PETACC 6 Trial by EORTC GITCG and ROG, AIO, AGITG, BGDO, and FFCD. J Clin Oncol. 2021 Jan 1;39(1):17-29. Epub 2020 Oct 1. [https://doi.org/10.1200/jco.20.01740 link to original article] '''contains dosing details in manuscript''' [https://pubmed.ncbi.nlm.nih.gov/33001764/ PubMed] NCT00766155
 ==Fluorouracil monotherapy {{#subobject:adc56e|Regimen=1}}==
+<div class="toccolours" style="background-color:#eeeeee">
 ===Regimen variant #1 {{#subobject:66d35a|Variant=1}}===
 {| class="wikitable sortable" style="width: 100%; text-align:center;"
@@ Line 1,005: / Line 1,076: @@
 |-
 |}
+<div class="toccolours" style="background-color:#cbd5e8">
 ====Preceding treatment====
 *[[#Fluorouracil_.26_RT|Neoadjuvant fluorouracil & RT]], then [[Surgery#Colorectal_cancer_surgery|surgery]]
+</div>
+<div class="toccolours" style="background-color:#b3e2cd">
 ====Chemotherapy====
 *[[Fluorouracil (5-FU)]] 500 mg/m<sup>2</sup> IV bolus once per day on days 1 to 5
 '''28-day cycle for 4 cycles'''
+</div></div><br>
+<div class="toccolours" style="background-color:#eeeeee">
 ===Regimen variant #2 {{#subobject:38a90a|Variant=1}}===
 {| class="wikitable sortable" style="width: 100%; text-align:center;"
@@ Line 1,028: / Line 1,102: @@
 |}
 ''<sup>1</sup>Reported efficacy is based on the 2015 update.''
+<div class="toccolours" style="background-color:#cbd5e8">
 ====Preceding treatment====
 *[[#Fluorouracil_.26_RT|Neoadjuvant fluorouracil & RT]], then [[Surgery#Colorectal_cancer_surgery|surgery]]
+</div>
+<div class="toccolours" style="background-color:#b3e2cd">
 ====Chemotherapy====
 *[[Fluorouracil (5-FU)]] 500 mg/m<sup>2</sup> IV bolus once per day on days 1 to 5, 29
 '''4 cycles (length not specified)'''
+</div></div>
 ===References===
 # '''Rektum-III:''' Hofheinz RD, Wenz F, Post S, Matzdorff A, Laechelt S, Hartmann JT, Müller L, Link H, Moehler M, Kettner E, Fritz E, Hieber U, Lindemann HW, Grunewald M, Kremers S, Constantin C, Hipp M, Hartung G, Gencer D, Kienle P, Burkholder I, Hochhaus A. Chemoradiotherapy with capecitabine versus fluorouracil for locally advanced rectal cancer: a randomised, multicentre, non-inferiority, phase 3 trial. Lancet Oncol. 2012 Jun;13(6):579-88. Epub 2012 Apr 12. [https://doi.org/10.1016/S1470-2045%2812%2970116-X link to original article] '''contains dosing details in manuscript''' [https://pubmed.ncbi.nlm.nih.gov/22503032 PubMed] NCT01500993
 # '''CAO/ARO/AIO-04:''' Rödel C, Liersch T, Becker H, Fietkau R, Hohenberger W, Hothorn T, Graeven U, Arnold D, Lang-Welzenbach M, Raab HR, Sülberg H, Wittekind C, Potapov S, Staib L, Hess C, Weigang-Köhler K, Grabenbauer GG, Hoffmanns H, Lindemann F, Schlenska-Lange A, Folprecht G, Sauer R; 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. 2012 Jul;13(7):679-87. Epub 2012 May 23. [https://doi.org/10.1016/S1470-2045(12)70187-0 link to original article] '''contains dosing details in abstract''' [https://pubmed.ncbi.nlm.nih.gov/22627104 PubMed] NCT00349076
 ## '''Update:''' Rödel C, Graeven U, Fietkau R, Hohenberger W, Hothorn T, Arnold D, Hofheinz RD, Ghadimi M, Wolff HA, Lang-Welzenbach M, Raab HR, Wittekind C, Ströbel P, Staib L, Wilhelm M, Grabenbauer GG, Hoffmanns H, Lindemann F, Schlenska-Lange A, Folprecht G, Sauer R, Liersch T; German Rectal Cancer Study Group. Oxaliplatin added to fluorouracil-based preoperative chemoradiotherapy and postoperative chemotherapy of locally advanced rectal cancer (the German CAO/ARO/AIO-04 study): final results of the multicentre, open-label, randomised, phase 3 trial. Lancet Oncol. 2015 Aug;16(8):979-89. Epub 2015 Jul 15. [https://doi.org/10.1016/S1470-2045(15)00159-X link to original article] [https://pubmed.ncbi.nlm.nih.gov/26189067 PubMed]
 ==FULV {{#subobject:d6c3bd|Regimen=1}}==
 FULV: 5-'''<u>FU</u>''' & '''<u>L</u>'''euco'''<u>V</u>'''orin (Folinic acid)
+<div class="toccolours" style="background-color:#eeeeee">
 ===Regimen variant #1, 500/500 {{#subobject:cc7508|Variant=1}}===
 {| class="wikitable sortable" style="width: 100%; text-align:center;"
@@ Line 1,059: / Line 1,134: @@
 |}
 ''Note: male patients were also randomized to MOF or MOF & RT; this is of historic interest, only.''
+<div class="toccolours" style="background-color:#cbd5e8">
 ====Preceding treatment====
 *[[Surgery#Colorectal_cancer_surgery|Surgery]]
+</div>
+<div class="toccolours" style="background-color:#b3e2cd">
 ====Chemotherapy====
 *[[Fluorouracil (5-FU)]] 500 mg/m<sup>2</sup> IV once per day on days 1, 8, 15, 22, 29, 36, '''given 1 hour after leucovorin'''
 *[[Folinic acid (Leucovorin)]] 500 mg/m<sup>2</sup> IV once per day on days 1, 8, 15, 22, 29, 36, '''given first'''
 '''8-week cycle for 6 cycles'''
+</div></div><br>
+<div class="toccolours" style="background-color:#eeeeee">
 ===Regimen variant #2, 1000/120 ("Nordic regimen") {{#subobject:9df33b|Variant=1}}===
 {| class="wikitable sortable" style="width: 100%; text-align:center;"
@@ Line 1,083: / Line 1,161: @@
 |}
 ''Note: this is an experimental arm that did not meet its primary endpoint; included here because other variants of this regimen have been used as a standard comparator. This is a component of a sequential treatment protocol; to our knowledge there are no references to support using it as a stand-alone treatment.''
+<div class="toccolours" style="background-color:#cbd5e8">
 ====Preceding treatment====
 *[[Regimen_classes#5-FU-based_chemoradiotherapy|5-FU-based chemoradiotherapy]] or [[#Radiation_therapy|RT]], then [[Surgery#Colorectal_cancer_surgery|surgery]]
+</div>
+<div class="toccolours" style="background-color:#b3e2cd">
 ====Chemotherapy====
 *[[Fluorouracil (5-FU)]] 500 mg/m<sup>2</sup> IV once per day on days 1 & 2, '''given first''' (total dose per cycle: 1000 mg/m<sup>2</sup>)
 *[[Folinic acid (Leucovorin)]] 60 mg/m<sup>2</sup> IV once per day on days 1 & 2, '''given second''' (total dose per cycle: 120 mg/m<sup>2</sup>)
 '''14-day cycle for 12 cycles'''
+</div></div><br>
+<div class="toccolours" style="background-color:#eeeeee">
 ===Regimen variant #3, 1900/100 {{#subobject:9df33b|Variant=1}}===
 {| class="wikitable sortable" style="width: 100%; text-align:center;"
@@ Line 1,107: / Line 1,188: @@
 |}
 ''Note: this is a component of a sequential treatment protocol; to our knowledge there are no references to support using it as a stand-alone treatment.''
+<div class="toccolours" style="background-color:#cbd5e8">
 ====Preceding treatment====
 *[[Regimen_classes#Fluoropyrimidine-based_chemoradiotherapy|Fluoropyrimidine-based chemoradiation]], then [[Surgery#Total_mesorectal_excision|TME]]
+</div>
+<div class="toccolours" style="background-color:#b3e2cd">
 ====Chemotherapy====
 *[[Fluorouracil (5-FU)]] 380 mg/m<sup>2</sup> IV once per day on days 1 to 5 (total dose per cycle: 1900 mg/m<sup>2</sup>)
 *[[Folinic acid (Leucovorin)]] 20 mg/m<sup>2</sup> IV once per day on days 1 to 5 (total dose per cycle: 100 mg/m<sup>2</sup>)
 '''28-day cycle for 4 cycles'''
+</div></div><br>
+<div class="toccolours" style="background-color:#eeeeee">
 ===Regimen variant #4, 2125/100 ("Mayo regimen") {{#subobject:9df33b|Variant=1}}===
 {| class="wikitable sortable" style="width: 100%; text-align:center;"
@@ Line 1,137: / Line 1,221: @@
 |}
 ''Note: this is an experimental arm that did not meet its primary endpoint; included here because it was eventually used to establish this regimen as a standard comparator. This is a component of a sequential treatment protocol; to our knowledge there are no references to support using it as a stand-alone treatment.''
+<div class="toccolours" style="background-color:#cbd5e8">
 ====Preceding treatment====
 *PROCTOR: [[Regimen_classes#5-FU-based_chemoradiotherapy|5-FU-based chemoradiotherapy]] or [[#Radiation_therapy|RT]], then [[Surgery#Colorectal_cancer_surgery|surgery]]
+</div>
+<div class="toccolours" style="background-color:#b3e2cd">
 ====Chemotherapy====
 *[[Fluorouracil (5-FU)]] 425 mg/m<sup>2</sup> IV once per day on days 1 to 5 (total dose per cycle: 2125 mg/m<sup>2</sup>)
 *[[Folinic acid (Leucovorin)]] 20 mg/m<sup>2</sup> IV once per day on days 1 to 5 (total dose per cycle: 100 mg/m<sup>2</sup>)
 '''4- to 5-week cycle for 6 cycles'''
+</div></div>
 ===References===
 # '''NSABP R-02:''' Wolmark N, Wieand HS, Hyams DM, Colangelo L, Dimitrov NV, Romond EH, Wexler M, Prager D, Cruz AB Jr, Gordon PH, Petrelli NJ, Deutsch M, Mamounas E, Wickerham DL, Fisher ER, Rockette H, Fisher B. Randomized trial of postoperative adjuvant chemotherapy with or without radiotherapy for carcinoma of the rectum: National Surgical Adjuvant Breast and Bowel Project Protocol R-02. J Natl Cancer Inst. 2000 Mar 1;92(5):388-96. [https://academic.oup.com/jnci/article/92/5/388/2606692 link to original article] '''contains dosing details in manuscript''' [https://pubmed.ncbi.nlm.nih.gov/10699069 PubMed]
@@ Line 1,151: / Line 1,237: @@
 # '''PROCTOR:''' Breugom AJ, van Gijn W, Muller EW, Berglund Å, van den Broek CB, Fokstuen T, Gelderblom H, Kapiteijn E, Leer JW, Marijnen CA, Martijn H, Meershoek-Klein Kranenbarg E, Nagtegaal ID, Påhlman L, Punt CJ, Putter H, Roodvoets AG, Rutten HJ, Steup WH, Glimelius B, van de Velde CJ; Dutch Colorectal Cancer Group; Nordic Gastrointestinal Tumour Adjuvant Therapy Group. Adjuvant chemotherapy for rectal cancer patients treated with preoperative (chemo)radiotherapy and total mesorectal excision: a Dutch Colorectal Cancer Group (DCCG) randomized phase III trial. Ann Oncol. 2015 Apr;26(4):696-701. Epub 2014 Dec 5. [https://doi.org/10.1093/annonc/mdu560 link to original article] '''contains dosing details in manuscript''' [https://pubmed.ncbi.nlm.nih.gov/25480874 PubMed] ISRCTN36266738
 # '''R98:''' Delbaldo C, Ychou M, Zawadi A, Douillard JY, André T, Guerin-Meyer V, Rougier P, Dupuis O, Faroux R, Jouhaud A, Quinaux E, Buyse M, Piedbois P; AERO; GERCOR; FNCLCC; FFCD. Postoperative irinotecan in resected stage II-III rectal cancer: final analysis of the French R98 Intergroup trial. Ann Oncol. 2015 Jun;26(6):1208-15. Epub 2015 Mar 3. [https://doi.org/10.1093/annonc/mdv135 link to original article] [https://pubmed.ncbi.nlm.nih.gov/25739671 PubMed]
 ==mFOLFOX6 {{#subobject:fad3f|Regimen=1}}==
 mFOLFOX6: '''<u>FOL</u>'''inic acid, '''<u>F</u>'''luorouracil, '''<u>OX</u>'''aliplatin
+<div class="toccolours" style="background-color:#eeeeee">
 ===Regimen variant #1, with 5-FU bolus, 8 cycles {{#subobject:f31fc0|Variant=1}}===
 {| class="wikitable sortable" style="width: 100%; text-align:center;"
@@ Line 1,171: / Line 1,255: @@
 |-
 |}
+<div class="toccolours" style="background-color:#cbd5e8">
 ====Preceding treatment====
 *[[Regimen_classes#Fluoropyrimidine-based_chemoradiotherapy|Fluoropyrimidine-based chemoradiation]], then [[Surgery#Total_mesorectal_excision|TME]]
+</div>
+<div class="toccolours" style="background-color:#b3e2cd">
 ====Chemotherapy====
 *[[Fluorouracil (5-FU)]] 400 mg/m<sup>2</sup> IV bolus on day 1, then 2400 mg/m<sup>2</sup> IV continuous infusion over 46 hours (total dose per cycle: 2800 mg/m<sup>2</sup>)
 *[[Folinic acid (Leucovorin)]] 200 mg/m<sup>2</sup> IV once on day 1
 *[[Oxaliplatin (Eloxatin)]] 85 mg/m<sup>2</sup> IV once on day 1
 '''14-day cycle for 8 cycles'''
+</div></div><br>
+<div class="toccolours" style="background-color:#eeeeee">
 ===Regimen variant #2, no 5-FU bolus, 8 cycles {{#subobject:f3300f|Variant=1}}===
 {| class="wikitable sortable" style="width: 100%; text-align:center;"
@@ Line 1,196: / Line 1,283: @@
 |}
 ''<sup>1</sup>Reported efficacy is based on the 2015 update.''
+<div class="toccolours" style="background-color:#cbd5e8">
 ====Preceding treatment====
 *[[#FUOX_.26_RT|Neoadjuvant FUOX & RT]], then [[Surgery#Colorectal_cancer_surgery|surgery]]
+</div>
+<div class="toccolours" style="background-color:#b3e2cd">
 ====Chemotherapy====
 *[[Fluorouracil (5-FU)]] 2400 mg/m<sup>2</sup> IV continuous infusion over 46 hours, started on day 1, '''given third''' (total dose per cycle: 2400 mg/m<sup>2</sup>)
 *[[Folinic acid (Leucovorin)]] 400 mg/m<sup>2</sup> IV over 2 hours once on day 1, '''given second'''
 *[[Oxaliplatin (Eloxatin)]] 100 mg/m<sup>2</sup> IV over 2 hours once on day 1, '''given first'''
 '''14-day cycle for 8 cycles'''
+</div></div><br>
+<div class="toccolours" style="background-color:#eeeeee">
 ===Regimen variant #3, 12 cycles {{#subobject:f3hg10|Variant=1}}===
 {| class="wikitable sortable" style="width: 100%; text-align:center;"
@@ Line 1,220: / Line 1,310: @@
 |-
 |}
+<div class="toccolours" style="background-color:#cbd5e8">
 ====Preceding treatment====
 *[[Regimen_classes#Fluoropyrimidine-based_chemoradiotherapy|Fluoropyrimidine-based chemoradiation]], then [[Surgery#Total_mesorectal_excision|TME]]
+</div>
+<div class="toccolours" style="background-color:#b3e2cd">
 ====Chemotherapy====
 *[[Fluorouracil (5-FU)]] 400 mg/m<sup>2</sup> IV bolus on day 1, then 2400 mg/m<sup>2</sup> IV continuous infusion over 46 hours (total dose per cycle: 2800 mg/m<sup>2</sup>)
 *[[Folinic acid (Leucovorin)]] 400 mg/m<sup>2</sup> IV over 2 hours once on day 1
 *[[Oxaliplatin (Eloxatin)]] 85 mg/m<sup>2</sup> IV over 2 hours once on day 1
 '''14-day cycle for 12 cycles'''
+</div></div>
 ===References===
 # '''ADORE:''' Hong YS, Nam BH, Kim KP, Kim JE, Park SJ, Park YS, Park JO, Kim SY, Kim TY, Kim JH, Ahn JB, Lim SB, Yu CS, Kim JC, Yun SH, Kim JH, Park JH, Park HC, Jung KH, Kim TW. Oxaliplatin, fluorouracil, and leucovorin versus fluorouracil and leucovorin as adjuvant chemotherapy for locally advanced rectal cancer after preoperative chemoradiotherapy (ADORE): an open-label, multicentre, phase 2, randomised controlled trial. Lancet Oncol. 2014 Oct;15(11):1245-53. Epub 2014 Sep 4. [https://doi.org/10.1016/S1470-2045(14)70377-8 link to original article] '''contains dosing details in abstract''' [https://pubmed.ncbi.nlm.nih.gov/25201358 PubMed] NCT00807911
@@ Line 1,235: / Line 1,327: @@
 ## '''Update:''' Rödel C, Graeven U, Fietkau R, Hohenberger W, Hothorn T, Arnold D, Hofheinz RD, Ghadimi M, Wolff HA, Lang-Welzenbach M, Raab HR, Wittekind C, Ströbel P, Staib L, Wilhelm M, Grabenbauer GG, Hoffmanns H, Lindemann F, Schlenska-Lange A, Folprecht G, Sauer R, Liersch T; German Rectal Cancer Study Group. Oxaliplatin added to fluorouracil-based preoperative chemoradiotherapy and postoperative chemotherapy of locally advanced rectal cancer (the German CAO/ARO/AIO-04 study): final results of the multicentre, open-label, randomised, phase 3 trial. Lancet Oncol. 2015 Aug;16(8):979-89. Epub 2015 Jul 15. [https://doi.org/10.1016/S1470-2045(15)00159-X link to original article] [https://pubmed.ncbi.nlm.nih.gov/26189067 PubMed]
 #'''ECOG E5204:''' Chakravarthy AB, Zhao F, Meropol NJ, Flynn PJ, Wagner LI, Sloan J, Diasio RB, Mitchell EP, Catalano P, Giantonio BJ, Catalano RB, Haller DG, Awan RA, Mulcahy MF, O'Brien TE, Santala R, Cripps C, Weis JR, Atkins JN, Leichman CG, Petrelli NJ, Sinicrope FA, Brierley JD, Tepper JE, O'Dwyer PJ, Sigurdson ER, Hamilton SR, Cella D, Benson AB 3rd. Intergroup Randomized Phase III Study of Postoperative Oxaliplatin, 5-Fluorouracil, and Leucovorin Versus Oxaliplatin, 5-Fluorouracil, Leucovorin, and Bevacizumab for Patients with Stage II or III Rectal Cancer Receiving Preoperative Chemoradiation: A Trial of the ECOG-ACRIN Research Group (E5204). Oncologist. 2020 May;25(5):e798-e807. Epub 2019 Dec 18. [https://doi.org/10.1634/theoncologist.2019-0437 link to original article] [https://www.ncbi.nlm.nih.gov/pmc/articles/pmc7216434/ link to PMC article] '''contains dosing details in manuscript''' [https://pubmed.ncbi.nlm.nih.gov/31852811/ PubMed] NCT00303628
 ==S-1 monotherapy {{#subobject:ec10ef|Regimen=1}}==
+<div class="toccolours" style="background-color:#eeeeee">
 ===Regimen {{#subobject:0ee98c|Variant=1}}===
 {| class="wikitable sortable" style="width: 100%; text-align:center;"
@@ Line 1,254: / Line 1,345: @@
 |}
 ''Note: these patients did not receive preoperative therapy.''
+<div class="toccolours" style="background-color:#cbd5e8">
 ====Preceding treatment====
 *Curative [[Surgery#Colorectal_cancer_surgery|resection]] for stage II or stage III rectal cancer, within 49 days
+</div>
+<div class="toccolours" style="background-color:#b3e2cd">
 ====Chemotherapy====
 *[[Tegafur, gimeracil, oteracil (S-1)]] by the following criteria:
@@ Line 1,261: / Line 1,355: @@
 **BSA 1.25 to 1.5 m<sup>2</sup>: 50 mg PO twice per day on days 1 to 28
 **BSA 1.5 or greater m<sup>2</sup>: 60 mg PO twice per day on days 1 to 28
 '''42-day cycle for 9 cycles (1 year)'''
+</div></div>
 ===References===
 # '''ACTS-RC:''' Oki E, Murata A, Yoshida K, Maeda K, Ikejiri K, Munemoto Y, Sasaki K, Matsuda C, Kotake M, Suenaga T, Matsuda H, Emi Y, Kakeji Y, Baba H, Hamada C, Saji S, Maehara Y. A randomized phase III trial comparing S-1 versus UFT as adjuvant chemotherapy for stage II/III rectal cancer (JFMC35-C1: ACTS-RC). Ann Oncol. 2016 Jul;27(7):1266-72. Epub 2016 Apr 7. [https://doi.org/10.1093/annonc/mdw162 link to original article] [https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4922318/ link to PMC article] '''contains dosing details in manuscript''' [https://pubmed.ncbi.nlm.nih.gov/27056996 PubMed] UMIN C000000385
 ==UFT monotherapy {{#subobject:0c1194|Regimen=1}}==
+<div class="toccolours" style="background-color:#eeeeee">
 ===Regimen {{#subobject:7dc55c|Variant=1}}===
 {| class="wikitable sortable" style="width: 100%; text-align:center;"
@@ Line 1,290: / Line 1,383: @@
 |}
 ''Note: these patients did not receive preoperative therapy.''
+<div class="toccolours" style="background-color:#cbd5e8">
 ====Preceding treatment====
 *Curative [[Surgery#Colorectal_cancer_surgery|resection]] for stage II or stage III rectal cancer, within 49 days
+</div>
+<div class="toccolours" style="background-color:#b3e2cd">
 ====Chemotherapy====
 *[[Tegafur and uracil (UFT)]] by the following criteria:
 **BSA less than 1.25 m<sup>2</sup>: 250 mg PO twice per day on days 1 to 5
 **BSA 1.25 or greater m<sup>2</sup>: 300 mg PO twice per day on days 1 to 5
 '''7-day cycle for 52 cycles'''
+</div></div>
 ===References===
 # '''NSAS-CC:''' Hamaguchi T, Shirao K, Moriya Y, Yoshida S, Kodaira S, Ohashi Y; NSAS-CC Group. Final results of randomized trials by the National Surgical Adjuvant Study of Colorectal Cancer (NSAS-CC). Cancer Chemother Pharmacol. 2011 Mar;67(3):587-96. Epub 2010 May 19. [https://doi.org/10.1007/s00280-010-1358-1 link to original article] [https://pubmed.ncbi.nlm.nih.gov/20490797 PubMed] NCT00152230
 # '''ACTS-RC:''' Oki E, Murata A, Yoshida K, Maeda K, Ikejiri K, Munemoto Y, Sasaki K, Matsuda C, Kotake M, Suenaga T, Matsuda H, Emi Y, Kakeji Y, Baba H, Hamada C, Saji S, Maehara Y. A randomized phase III trial comparing S-1 versus UFT as adjuvant chemotherapy for stage II/III rectal cancer (JFMC35-C1: ACTS-RC). Ann Oncol. 2016 Jul;27(7):1266-72. Epub 2016 Apr 7. [https://doi.org/10.1093/annonc/mdw162 link to original article] [https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4922318/ link to PMC article] '''contains dosing details in manuscript''' [https://pubmed.ncbi.nlm.nih.gov/27056996 PubMed] UMIN C000000385
 =Adjuvant chemoradiotherapy=
 ==Capecitabine/Capecitabine & RT {{#subobject:4c3312|Regimen=1}}==
 Capecitabine/Capecitabine & RT: Capecitabine alternating with Capecitabine & '''<u>R</u>'''adiation '''<u>T</u>'''herapy
+<div class="toccolours" style="background-color:#eeeeee">
 ===Protocol {{#subobject:2028c1|Variant=1}}===
 {| class="wikitable sortable" style="width: 100%; text-align:center;"
@@ Line 1,323: / Line 1,416: @@
 |-
 |}
+<div class="toccolours" style="background-color:#cbd5e8">
 ====Preceding treatment====
 *[[Surgery#Colorectal_cancer_surgery|Surgery]]
+</div>
+<div class="toccolours" style="background-color:#b3e2cd">
 ====Chemotherapy, part 1====
 *[[Capecitabine (Xeloda)]] 1250 mg/m<sup>2</sup> PO twice per day on days 1 to 14
 '''21-day cycle for 2 cycles, followed by:'''
 ====Chemotherapy, part 2====
 *[[Capecitabine (Xeloda)]] 825 mg/m<sup>2</sup> PO twice per day on days 1 to 38
 ====Radiotherapy====
 *Concurrent [[External_beam_radiotherapy|radiation therapy]], 50.4 Gy total
 '''Followed by:'''
 ====Chemotherapy, part 3====
 *[[Capecitabine (Xeloda)]] 1250 mg/m<sup>2</sup> PO twice per day on days 1 to 14
 '''21-day cycle for 3 cycles'''
+</div></div>
 ===References===
 # '''Rektum-III:''' Hofheinz RD, Wenz F, Post S, Matzdorff A, Laechelt S, Hartmann JT, Müller L, Link H, Moehler M, Kettner E, Fritz E, Hieber U, Lindemann HW, Grunewald M, Kremers S, Constantin C, Hipp M, Hartung G, Gencer D, Kienle P, Burkholder I, Hochhaus A. Chemoradiotherapy with capecitabine versus fluorouracil for locally advanced rectal cancer: a randomised, multicentre, non-inferiority, phase 3 trial. Lancet Oncol. 2012 Jun;13(6):579-88. Epub 2012 Apr 12. [https://doi.org/10.1016/S1470-2045%2812%2970116-X link to original article] '''contains dosing details in manuscript''' [https://pubmed.ncbi.nlm.nih.gov/22503032 PubMed] NCT01500993
 ==Capecitabine & RT {{#subobject:3cec7f|Regimen=1}}==
 Capecitabine & RT: Capecitabine & '''<u>R</u>'''adiation '''<u>T</u>'''herapy
+<div class="toccolours" style="background-color:#eeeeee">
 ===Regimen {{#subobject:5ea375|Variant=1}}===
 {| class="wikitable sortable" style="width: 100%; text-align:center;"
@@ Line 1,363: / Line 1,453: @@
 |-
 |}
+<div class="toccolours" style="background-color:#cbd5e8">
 ====Preceding treatment====
 *[[Surgery#Colorectal_cancer_surgery|Surgery]]
+</div>
+<div class="toccolours" style="background-color:#b3e2cd">
 ====Chemotherapy====
 *[[Capecitabine (Xeloda)]] 800 mg/m<sup>2</sup> PO twice per day on days 1 to 14
@@ Line 1,370: / Line 1,463: @@
 ====Radiotherapy====
 *Concurrent [[External_beam_radiotherapy|radiation therapy]], 45 to 50.4 Gy total in 25 to 28 fractions
 '''5- to 5.5-week course'''
+</div></div>
 ===References===
 # '''CAMS rectal cancer 01:''' Feng YR, Zhu Y, Liu LY, Wang WH, Wang SL, Song YW, Wang X, Tang Y, Liu YP, Ren H, Fang H, Zhang SP, Liu XF, Yu ZH, Li YX, Jin J. Interim analysis of postoperative chemoradiotherapy with capecitabine and oxaliplatin versus capecitabine alone for pathological stage II and III rectal cancer: a randomized multicenter phase III trial. Oncotarget. 2016 May 3;7(18):25576-84. [http://www.oncotarget.com/index.php?journal=oncotarget&page=article&op=view&path%5B%5D=8226&path%5B%5D=24328 link to original article] [https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5041927/ link to PMC article] '''contains dosing details in manuscript''' [https://pubmed.ncbi.nlm.nih.gov/27014909 PubMed] NCT00714077
 ==Fluorouracil & RT {{#subobject:25293e|Regimen=1}}==
 Fluorouracil & RT: Fluorouracil & '''<u>R</u>'''adiation '''<u>T</u>'''herapy
+<div class="toccolours" style="background-color:#eeeeee">
 ===Regimen {{#subobject:e903ad|Variant=1}}===
 {| class="wikitable sortable" style="width: 100%; text-align:center;"
@@ Line 1,394: / Line 1,485: @@
 |-
 |}
+<div class="toccolours" style="background-color:#b3e2cd">
 ====Chemotherapy====
 *[[Fluorouracil (5-FU)]]
 ====Radiotherapy====
 *[[External_beam_radiotherapy|Radiation therapy]]
+</div></div>
 ===References===
 # Fountzilas G, Zisiadis A, Dafni U, Konstantaras C, Hatzitheoharis G, Liaros A, Athanassiou E, Dombros N, Dervenis C, Basdanis G, Gamvros O, Souparis A, Briasoulis E, Samantas E, Kappas A, Kosmidis P, Skarlos D, Pavlidis N; Hellenic Cooperative Oncology Group. Postoperative radiation and concomitant bolus fluorouracil with or without additional chemotherapy with fluorouracil and high-dose leucovorin in patients with high-risk rectal cancer: a randomized phase III study conducted by the Hellenic Cooperative Oncology Group. Ann Oncol. 1999 Jun;10(6):671-6. [https://doi.org/10.1023/a:1008357609434 link to original article] [https://pubmed.ncbi.nlm.nih.gov/10442189 PubMed]
 ==Fluorouracil/Fluorouracil & RT {{#subobject:423753|Regimen=1}}==
 Fluorouracil/Fluorouracil & RT: Fluorouracil alternating with Fluorouracil & '''<u>R</u>'''adiation '''<u>T</u>'''herapy
+<div class="toccolours" style="background-color:#eeeeee">
 ===Protocol variant #1, Bolus 5-FU (500 mg/m<sup>2</sup>), then CI 5-FU & RT, then Bolus 5-FU (450 mg/m<sup>2</sup>) {{#subobject:d06581|Variant=1}}===
 {| class="wikitable sortable" style="width: 100%; text-align:center;"
@@ Line 1,431: / Line 1,521: @@
 |}
 ''Note: INT 864751 also included a randomization to add semustine, which is only of historic interest.''
+<div class="toccolours" style="background-color:#cbd5e8">
 ====Preceding treatment====
 *[[Surgery#Colorectal_cancer_surgery|Surgery]]
+</div>
+<div class="toccolours" style="background-color:#b3e2cd">
 ====Chemotherapy, part 1====
 *[[Fluorouracil (5-FU)]] 500 mg/m<sup>2</sup> IV bolus once per day on days 1 to 5
 '''28-day cycle for 2 cycles, followed immediately by:'''
 ====Chemotherapy, part 2====
 *[[Fluorouracil (5-FU)]] 225 mg/m<sup>2</sup>/day IV continuous infusion while radiation is being given
 ====Radiotherapy====
 *Concurrent [[External_beam_radiotherapy|radiation therapy]], 1.8 Gy fractions x 25 fractions for an initial dose of 45 Gy, which is followed by a 1.8 Gy x 3 fraction (5.4 Gy total) boost to the tumor bed and adjacent lymph nodes, and then optionally a 1.8 Gy x 2 fraction (3.6 Gy total) boost to the tumor bed and a 2 cm margin if the small bowel could be avoided
 '''6-week course, followed 28 days later by:'''
 ====Chemotherapy, part 3====
 *[[Fluorouracil (5-FU)]] 450 mg/m<sup>2</sup> IV bolus once per day on days 1 to 5
 '''28-day cycle for 2 cycles'''
+</div></div><br>
+<div class="toccolours" style="background-color:#eeeeee">
 ===Protocol variant #2, Bolus 5-FU (500 mg/m<sup>2</sup>), then CI 5-FU & RT, then Bolus 5-FU (500 mg/m<sup>2</sup>) {{#subobject:23bcde|Variant=1}}===
 {| class="wikitable sortable" style="width: 100%; text-align:center;"
@@ Line 1,465: / Line 1,554: @@
 |-
 |}
+<div class="toccolours" style="background-color:#cbd5e8">
 ====Preceding treatment====
 *[[Surgery#Colorectal_cancer_surgery|Surgery]]
+</div>
+<div class="toccolours" style="background-color:#b3e2cd">
 ====Chemotherapy, part 1====
 *[[Fluorouracil (5-FU)]] 500 mg/m<sup>2</sup> IV bolus once per day on days 1 to 5
 '''28-day cycle for 2 cycles, followed by:'''
 ====Chemotherapy, part 2====
 *[[Fluorouracil (5-FU)]] 225 mg/m<sup>2</sup>/day IV continuous infusion while radiation is being given
 ====Radiotherapy====
 *Concurrent [[External_beam_radiotherapy|radiation therapy]], 50.4 Gy total
 '''Followed by:'''
 ====Chemotherapy, part 3====
 *[[Fluorouracil (5-FU)]] 500 mg/m<sup>2</sup> IV bolus once per day on days 1 to 5
 '''28-day cycle for 2 cycles'''
+</div></div><br>
+<div class="toccolours" style="background-color:#eeeeee">
 ===Protocol variant #3, CI 5-FU, then CI 5-FU & RT, then CI 5-FU {{#subobject:da8c0d|Variant=1}}===
 {| class="wikitable sortable" style="width: 100%; text-align:center;"
@@ Line 1,502: / Line 1,590: @@
 |-
 |}
+<div class="toccolours" style="background-color:#cbd5e8">
 ====Preceding treatment====
 *[[Surgery#Colorectal_cancer_surgery|Surgery]]
+</div>
+<div class="toccolours" style="background-color:#b3e2cd">
 ====Chemotherapy, part 1====
 *[[Fluorouracil (5-FU)]] 300 mg/m<sup>2</sup>/day IV continuous infusion over 42 days, started on day 1 (total dose: 12,600 mg/m<sup>2</sup>)
 '''8-week course, followed in 2 weeks by:'''
 ====Chemotherapy, part 2====
 *[[Fluorouracil (5-FU)]] 225 mg/m<sup>2</sup>/day IV continuous infusion while radiation is being given
 ====Radiotherapy====
 *Concurrent [[External_beam_radiotherapy|radiation therapy]], 1.8 Gy fractions x 25 fractions for an initial dose of 45 Gy, which is followed by a 1.8 Gy x 3 fraction (5.4 Gy total) boost to the tumor bed and adjacent lymph nodes, and then optionally a 1.8 Gy x 2 fraction (3.6 Gy total) boost to the tumor bed and a 2 cm margin if the small bowel could be avoided
 '''Followed in 28 days by:'''
 ====Chemotherapy, part 3====
 *[[Fluorouracil (5-FU)]] 300 mg/m<sup>2</sup>/day IV continuous infusion over 56 days, started on day 1 (total dose: 16,800 mg/m<sup>2</sup>)
 '''56-day course'''
+</div></div><br>
+<div class="toccolours" style="background-color:#eeeeee">
 ===Protocol variant #4, bolus 5-FU, then bolus 5-FU & RT, then bolus 5-FU {{#subobject:3d1b7b|Variant=1}}===
 {| class="wikitable sortable" style="width: 100%; text-align:center;"
@@ Line 1,549: / Line 1,636: @@
 |}
 ''Note: INT 864751 also included a randomization to add semustine, which is only of historic interest.''
+<div class="toccolours" style="background-color:#cbd5e8">
 ====Preceding treatment====
 *[[Surgery#Colorectal_cancer_surgery|Surgery]]
+</div>
+<div class="toccolours" style="background-color:#b3e2cd">
 ====Chemotherapy, part 1====
 *[[Fluorouracil (5-FU)]] 500 mg/m<sup>2</sup> IV bolus once per day on days 1 to 5
 '''28-day cycle for 2 cycles, followed by:'''
 ====Chemotherapy, part 2====
 *[[Fluorouracil (5-FU)]] 500 mg/m<sup>2</sup> IV bolus 3 days per week during weeks 1 & 5 of radiation, preferably within 2 hours after the day's radiation
 ====Radiotherapy====
 *Concurrent [[External_beam_radiotherapy|radiation therapy]], 1.8 Gy fractions x 25 fractions for an initial dose of 45 Gy, which is followed by a 1.8 Gy x 3 fraction (5.4 Gy total) boost to the tumor bed and adjacent lymph nodes, and then optionally a 1.8 Gy x 2 fraction (3.6 Gy total) boost to the tumor bed and a 2 cm margin if the small bowel could be avoided
 '''Followed in 28 days by:'''
 ====Chemotherapy, part 3====
 *[[Fluorouracil (5-FU)]] 450 mg/m<sup>2</sup> IV bolus once per day on days 1 to 5
 '''28-day cycle for 2 cycles'''
+</div></div>
 ===References===
 # '''INT 864751:''' O'Connell MJ, Martenson JA, Wieand HS, Krook JE, Macdonald JS, Haller DG, Mayer RJ, Gunderson LL, Rich TA. Improving adjuvant therapy for rectal cancer by combining protracted-infusion fluorouracil with radiation therapy after curative surgery. N Engl J Med. 1994 Aug 25;331(8):502-7. [https://doi.org/10.1056/NEJM199408253310803 link to original article] '''contains dosing details in manuscript''' [https://pubmed.ncbi.nlm.nih.gov/8041415 PubMed]
@@ Line 1,574: / Line 1,659: @@
 # '''GI INT 0144:''' Smalley SR, Benedetti JK, Williamson SK, Robertson JM, Estes NC, Maher T, Fisher B, Rich TA, Martenson JA, Kugler JW, Benson AB 3rd, Haller DG, Mayer RJ, Atkins JN, Cripps C, Pedersen J, Periman PO, Tanaka MS Jr, Leichman CG, Macdonald JS. Phase III trial of fluorouracil-based chemotherapy regimens plus radiotherapy in postoperative adjuvant rectal cancer: GI INT 0144. J Clin Oncol. 2006 Aug 1;24(22):3542-7. [https://doi.org/10.1200/jco.2005.04.9544 link to original article] '''contains dosing details in manuscript''' [https://pubmed.ncbi.nlm.nih.gov/16877719 PubMed] NCT00002551
 # '''Rektum-III:''' Hofheinz RD, Wenz F, Post S, Matzdorff A, Laechelt S, Hartmann JT, Müller L, Link H, Moehler M, Kettner E, Fritz E, Hieber U, Lindemann HW, Grunewald M, Kremers S, Constantin C, Hipp M, Hartung G, Gencer D, Kienle P, Burkholder I, Hochhaus A. Chemoradiotherapy with capecitabine versus fluorouracil for locally advanced rectal cancer: a randomised, multicentre, non-inferiority, phase 3 trial. Lancet Oncol. 2012 Jun;13(6):579-88. Epub 2012 Apr 13. [https://doi.org/10.1016/S1470-2045%2812%2970116-X link to original article] '''contains dosing details in manuscript''' [https://pubmed.ncbi.nlm.nih.gov/22503032 PubMed] NCT01500993
 ==FULV/FULV & RT {{#subobject:e9de02|Regimen=1}}==
 FULV/FULV & RT: '''<u>F</u>'''luoro'''<u>U</u>'''racil & '''<u>L</u>'''euco'''<u>V</u>'''orin (Folinic acid) alternating with '''<u>F</u>'''luoro'''<u>U</u>'''racil, '''<u>L</u>'''euco'''<u>V</u>'''orin (Folinic acid) & '''<u>R</u>'''adiation '''<u>T</u>'''herapy
+<div class="toccolours" style="background-color:#eeeeee">
 ===Protocol {{#subobject:cd06ac|Variant=1}}===
 {| class="wikitable sortable" style="width: 100%; text-align:center;"
@@ Line 1,605: / Line 1,689: @@
 |-
 |}
+<div class="toccolours" style="background-color:#cbd5e8">
 ====Preceding treatment====
 *[[Surgery#Colorectal_cancer_surgery|Surgery]]
+</div>
+<div class="toccolours" style="background-color:#b3e2cd">
 ====Chemotherapy, part 1====
 *[[Fluorouracil (5-FU)]] 425 mg/m<sup>2</sup> IV bolus once per day on days 1 to 5, '''given second'''
 *[[Folinic acid (Leucovorin)]] 20 mg/m<sup>2</sup> IV bolus once per day on days 1 to 5, '''given first'''
 '''28-day cycle for 2 cycles, followed by:'''
 ====Chemotherapy, part 2====
 *[[Fluorouracil (5-FU)]] 400 mg/m<sup>2</sup> IV bolus 4 days per week during weeks 1 & 5 of radiation, preferably within 2 hours after the day's radiation
@@ Line 1,618: / Line 1,703: @@
 ====Radiotherapy====
 *Concurrent [[External_beam_radiotherapy|radiation therapy]], 1.8 Gy fractions x 25 fractions for an initial dose of 45 Gy, which is followed by a 1.8 Gy x 3 fraction (5.4 Gy total) boost to the tumor bed and adjacent lymph nodes, and then optionally a 1.8 Gy x 2 fraction (3.6 Gy total) boost to the tumor bed and a 2 cm margin if the small bowel could be avoided
 '''Followed in 28 days by:'''
 ====Chemotherapy, part 3====
 *[[Fluorouracil (5-FU)]] 380 mg/m<sup>2</sup> IV bolus once per day on days 1 to 5
 *[[Folinic acid (Leucovorin)]] 20 mg/m<sup>2</sup> IV bolus once per day on days 1 to 5
 '''28-day cycle for 2 cycles'''
+</div></div>
 ===References===
 # '''GI INT 0114:''' Tepper JE, O'Connell MJ, Petroni GR, Hollis D, Cooke E, Benson AB 3rd, Cummings B, Gunderson LL, Macdonald JS, Martenson JA. Adjuvant postoperative fluorouracil-modulated chemotherapy combined with pelvic radiation therapy for rectal cancer: initial results of intergroup 0114. J Clin Oncol. 1997 May;15(5):2030-9. [https://doi.org/10.1200/jco.1997.15.5.2030 link to original article] '''contains dosing details in manuscript''' [https://pubmed.ncbi.nlm.nih.gov/9164215 PubMed]
 ## '''Update:''' Tepper JE, O'Connell M, Niedzwiecki D, Hollis DR, Benson AB 3rd, Cummings B, Gunderson LL, Macdonald JS, Martenson JA, Mayer RJ. Adjuvant therapy in rectal cancer: analysis of stage, sex, and local control--final report of intergroup 0114. J Clin Oncol. 2002 Apr 1;20(7):1744-50. [https://doi.org/10.1200/jco.2002.07.132 link to original article] '''contains dosing details in manuscript''' [https://pubmed.ncbi.nlm.nih.gov/11919230 PubMed]
 # Kalofonos HP, Bamias A, Koutras A, Papakostas P, Basdanis G, Samantas E, Karina M, Misailidou D, Pisanidis N, Pentheroudakis G, Economopoulos T, Papadimitriou C, Skarlos DV, Pectasides D, Stavropoulos M, Bafaloukos D, Kardamakis D, Karanikiotis C, Vourli G, Fountzilas G; Hellenic Cooperative Oncology Group. A randomised phase III trial of adjuvant radio-chemotherapy comparing Irinotecan, 5FU and Leucovorin to 5FU and Leucovorin in patients with rectal cancer: a Hellenic Cooperative Oncology Group Study. Eur J Cancer. 2008 Aug;44(12):1693-700. Epub 2008 Jul 17. [https://www.ejcancer.com/article/S0959-8049(08)00411-5 link to original article] [https://pubmed.ncbi.nlm.nih.gov/18639450 PubMed]
 ==Radiation therapy {{#subobject:3f3b45|Regimen=1}}==
 RT: '''<u>R</u>'''adiation '''<u>T</u>'''herapy
+<div class="toccolours" style="background-color:#eeeeee">
 ===Regimen {{#subobject:f7cd24|Variant=1}}===
 {| class="wikitable sortable" style="width: 100%; text-align:center;"
@@ Line 1,665: / Line 1,746: @@
 |-
 |}
-''Of historic interest.''
+''Note: this regimen is of historic interest.''
+<div class="toccolours" style="background-color:#cbd5e8">
 ====Preceding treatment====
 *[[Surgery#Colorectal_cancer_surgery|Surgery]]
+</div>
+<div class="toccolours" style="background-color:#b3e2cd">
 ====Radiotherapy====
 *[[External_beam_radiotherapy|Radiation therapy]], 40 to 50.4 Gy
 '''4-week course'''
+</div></div>
 ===References===
 # '''NSABP R-01:''' Fisher B, Wolmark N, Rockette H, Redmond C, Deutsch M, Wickerham DL, Fisher ER, Caplan R, Jones J, Lerner H, Gordon P, Feldman M, Cruz A, Legault-Poisson S, Wexler M, Lawrence W, Robidoux A. Postoperative adjuvant chemotherapy or radiation therapy for rectal cancer: results from NSABP protocol R-01. J Natl Cancer Inst. 1988 Mar 2;80(1):21-9. [https://academic.oup.com/jnci/article-abstract/80/1/21/886000 link to original article] [https://pubmed.ncbi.nlm.nih.gov/3276900 PubMed]
@@ Line 1,678: / Line 1,761: @@
 # Amott SJ, Stenning SP, Hardcastle JD; Medical Research Council Rectal Cancer Working Party. Randomised trial of surgery alone versus surgery followed by radiotherapy for mobile cancer of the rectum. Lancet. 1996 Dec 14;348(9042):1610-4. [https://doi.org/10.1016/S0140-6736(96)05349-4 link to original article] '''contains dosing details in abstract''' [https://pubmed.ncbi.nlm.nih.gov/8961990 PubMed]
 # '''TROG 01.014:''' Ngan SY, Burmeister B, Fisher RJ, Solomon M, Goldstein D, Joseph D, Ackland SP, Schache D, McClure B, McLachlan SA, McKendrick J, Leong T, Hartopeanu C, Zalcberg J, Mackay J. Randomized trial of short-course radiotherapy versus long-course chemoradiation comparing rates of local recurrence in patients with T3 rectal cancer: Trans-Tasman Radiation Oncology Group trial 01.04. J Clin Oncol. 2012 Nov 1;30(31):3827-33. Epub 2012 Sep 24. Erratum in: J Clin Oncol. 2013 Jan 20;31(3):399. [https://doi.org/10.1200/JCO.2012.42.9597 link to original article] [https://pubmed.ncbi.nlm.nih.gov/23008301 PubMed] NCT00351598
 =Advanced or metastatic disease=
 ''See the [[Colorectal cancer|colorectal cancer page]] for colorectal cancer regimens.''
 [[Category:Rectal cancer regimens]]
 [[Category:Disease-specific pages]]
 [[Category:Colorectal cancers]]

Difference between revisions of "Rectal cancer"

Revision as of 00:45, 12 October 2022

Guidelines

ESMO

Older

NCCN

SIOG

Neoadjuvant therapy

Capecitabine & RT

Regimen variant #1, interrupted capecitabine, 1600 mg/m2/day, 45 Gy

Chemotherapy

Radiotherapy

Subsequent treatment

Regimen variant #2, interrupted capecitabine, 1600 mg/m2/day, 50 Gy

Preceding treatment

Chemotherapy

Radiotherapy

Subsequent treatment

Regimen variant #3, interrupted capecitabine, 1650 mg/m2/day, 45 Gy

Chemotherapy

Radiotherapy

Subsequent treatment

Regimen variant #4, continuous capecitabine, 1650 mg/m2/day, 45 Gy

Chemotherapy

Radiotherapy

Subsequent treatment

Regimen variant #5, interrupted capecitabine, 1650 mg/m2/day, 50 Gy

Chemotherapy

Radiotherapy

Subsequent treatment

Regimen variant #6, interrupted capecitabine, 1650 mg/m2/day, 50.4 Gy

Chemotherapy

Radiotherapy

Subsequent treatment

References

Capecitabine, Sorafenib, RT

Regimen

Chemotherapy

Targeted therapy

Radiotherapy

Subsequent treatment

References

CapeOx

Regimen variant #1, 4 cycles

Chemotherapy

Subsequent treatment

Regimen variant #2, 6 cycles

Preceding treatment

Chemotherapy

Subsequent treatment

References

CapeOx, Cetuximab, RT

Regimen

Chemotherapy

Targeted therapy

Radiotherapy

Subsequent treatment

References

CapIriRT

Regimen variant #1, 65 mg/m2

Biomarker eligibility criteria

Chemotherapy

Radiotherapy

Subsequent treatment

Regimen variant #2, 80 mg/m2

Biomarker eligibility criteria

Chemotherapy

Radiotherapy

Subsequent treatment

References

Fluorouracil & RT

Regimen variant #1, continuous

Chemotherapy

Radiotherapy

Subsequent treatment

Regimen variant #2, intermittent

Chemotherapy

Radiotherapy

Subsequent treatment

References

Regimen variant #1, interrupted capecitabine, 1600 mg/m²/day, 45 Gy

Regimen variant #2, interrupted capecitabine, 1600 mg/m²/day, 50 Gy

Regimen variant #3, interrupted capecitabine, 1650 mg/m²/day, 45 Gy

Regimen variant #4, continuous capecitabine, 1650 mg/m²/day, 45 Gy

Regimen variant #5, interrupted capecitabine, 1650 mg/m²/day, 50 Gy

Regimen variant #6, interrupted capecitabine, 1650 mg/m²/day, 50.4 Gy

Regimen variant #1, 65 mg/m²

Regimen variant #2, 80 mg/m²

Regimen variant #1, 2000 mg/m²/day x 6

Regimen variant #2, 2500 mg/m²/day x 5

Regimen variant #3, 2500 mg/m²/day x 8