Preoperative Chemo-radiation With IG-IMRT Dose Escalation for Locally Advanced Rectal Cancers

Inclusion criteria

• Adenocarcinoma of the rectum cT3 or cT4 or cN+, M0 and for which CPR recommends preoperative radiochemotherapy
• Tumor <15 cm of the anal margin in rigid or subperitoneal rectoscopy at the MRI
• Tumor potentially resectable from the outset, or considered to be resectable after radiochemotherapy
• Operable Patient
• Age between 18 and 75
• OMS performance status 0-2
• No co-morbidity likely to prevent the delivery of treatment
• Adequate contraception for men, and for non-menopausal women
• Neurotrophic neutrophils 1500 / mm3, platelets 100 000 / mm3, and hemoglobin 10 g / dL
• Bilirubin ≤ 1.5 times the upper limit of normal (LNS), ASAT and ALAT ≤ 1.5LNS, Alkaline phosphatase ≤ 1.5 LNS
• Creatinine clearance> 50 mL / min
• Patient must have been informed and must have signed the specific informed consent form.
• Patient must be affiliated to a Social Health Insurance.

Exclusion criteria

• Remote metastasis
• Cancer not resectable
• Contraindication to capecitabine and its excipients
• Previous history of pelvic radiotherapy or previous chemotherapy
• History of inflammatory bowel or rectum disease
• History of angina pectoris monitored or myocardial infarction or heart failure
• Active active infection or other serious underlying condition that may prevent the patient from receiving treatment
• Other concomitant cancer, or history of cancer other than in situ cancer of the treated cervix or basal cell carcinoma or squamous cell carcinoma
• Patient already included in another therapeutic trial with an experimental molecule
• Pregnant woman, likely to be pregnant or nursing
• Persons deprived of their liberty or under guardianship
• Patient unable to comply with the required medical follow-up for geographic, social or psychological reasons