Symptoms and General Pathology

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Digestive System Diseases

Recurrence

Rectal Neoplasms

Colorectal Neoplasms

Intestinal Neoplasms

Gastrointestinal Neoplasms

Digestive System Neoplasms

Gastrointestinal Diseases

Intestinal Diseases

Rectal Diseases

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All Drugs and Chemicals

Micronutrients

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Oxaliplatin

Leucovorin

Fluorouracil

Irinotecan

Capecitabine

Levoleucovorin

Folic Acid

Folfirinox

Folinic Acid

Folate

Vitamin B9

Protocol of chemotherapy FOLFIRINOX\*, 6 cycles :

* oxaliplatin: 85 mg/m2
* irinotecan: 180 mg/m²
* folinic acid: 400 mg/m2
* 5FU : 400 mg/m2 (bolus)
* 5FU : 2400 mg/m2 (continuous infusion)

Protocol of reirradiation consists in conformational intensity modulated external irradiation, delivering a 30.6 Gy dose (1.8 Gy/day), with concomitant chemotherapy including Capecitabine 1600 mg/m²/day, five days a week.

Protocol of chemotherapy FOLFIRINOX\*, 6 cycles :

* oxaliplatin: 85 mg/m2
* irinotecan: 180 mg/m²
* folinic acid: 400 mg/m2
* 5FU : 400 mg/m2 (bolus)
* 5FU : 2400 mg/m2 (continuous infusion)

* oxaliplatin: 85 mg/m2
* irinotecan: 180 mg/m²
* folinic acid: 400 mg/m2
* 5FU : 400 mg/m2 (bolus)
* 5FU : 2400 mg/m2 (continuous infusion)

Chemotherapy FOLFIRINOX, 6 cycles

Reirradiation consists in conformational intensity modulated external irradiation (Intensity-modulated radiotherapy Volumetric Modulated Arc Therapy or tomotherapy) delivering a 30.6 Gy dose with high-energy photons in fractions of 1.8 Gy per day (17 fractions) 5 days a week With Concomitant chemotherapy including Capecitabine 1600 mg/m²/day, five days a week.

Radiochemotherapy

Surgery will be performed at:

* Arm A: 8 weeks (±1) after the end of treatment
* Arm B: 6 weeks (±1) after the end of treatment

Surgical procedures are defined into three categories:

* Total mesorectal excision (TME)
* Extended-TEM (e-TME)
* Pelvic exenteration (PE)

Surgery

Christophe LAURENT

GRECCAR 15 is focused on Locally Recurrent Rectal Cancer (LRRC) for patients with previous pelvic radiotherapy for the primary rectal cancer. This situation leads to a 20% higher risk of non-curative resection for the LRRC management (R1 status) impacting significantly the overall survival. The widespread use of neoadjuvant radiotherapy for primary rectal cancer introduces this new problem: the treatment of LRRC in previously irradiated area.

The objective of GRECCAR 15 is to assess the efficacy of neoadjuvant chemotherapy followed by pelvic reirradiation versus neoadjuvant chemotherapy alone on the rate of curative surgery (R0) in previously irradiated patients with LRRC.

The incidence of rectal cancer in the European Union is 15-25/100 000 per year. There is a 5-10% rate of locally recurrent rectal cancer (LRRC), with an overall survival rate of 40% at 5 years after complete resection. Curative surgery of LRRC requires multi-visceral resections which are associated with significant post-operative morbidity of 60%. Despite the combination of a potential curability and the high post-operative morbidity, there are currently neither good data from prospective randomized studies regarding optimum preoperative treatments for LRRC nor is there data assessing the efﬁcacy of response to any such treatments. Moreover, the widespread use of neoadjuvant radiotherapy for primary cancer introduced a new problem: the treatment of LRRC in previously irradiated area. Some studies investigated various modalities of reirradiation and showed acceptable late toxicity and encouraging outcome. GRECCAR 15 would be the first prospective randomized trial so far to evaluate the interest of pelvic reirradiation for LRRC, in previously irradiated patients.

The objective is to assess the efficacy of neoadjuvant chemotherapy followed by pelvic reirradiation versus neoadjuvant chemotherapy alone on the rate of curative surgery (R0) in previously irradiated patients with LRRC.

Patients will be followed every 4 months during 2 years, and every 6 months the last year with chest, abdominal and pelvic scan and tumour markers.

Chemotherapy Followed by Pelvic Reirradiation Versus Chemotherapy Alone as Pre-operative Treatment for Locally Recurrent Rectal Cancer

A Phase III Randomized Trial Evaluating Chemotherapy Followed by Pelvic Reirradiation Versus Chemotherapy Alone as Pre-operative Treatment for Locally Recurrent Rectal Cancer (GRECCAR - PRODIGE - FRENCH)

To analyse surgical morbidity (Dindo classification) during first 30 days after the surgery

To analyse surgical mortality (Dindo classification) during first 30 days after the surgery

Proportion of patients receiving full allocated neoadjuvant treatment

Rate of tumor with a decreasing size of 50% at least after preoperative treatment at MRI

The scores of questionnaire QLQ C-30 will be examined The EORTC QLQ-C30 is a patients self-rating questionnaire that measures physical, role, social, emotional, and cognitive functions as well as overall QoL. Scores can be linearly transformed to provide a score from 0 to 100. Higher scores represent better functioning on the functional scales and a higher level of symptoms of the symptom scales.

The scores of questionnaire QLQ CR-29 will be examined. The EORTC QLQ-CR29 has five functional and 18 symptom scales. Scores can be linearly transformed to provide a score from 0 to 100. Higher scores represent better functioning on the functional scales and a higher level of symptoms of the symptom scales.

Spots Global Cancer Trial Database for chemotherapy folfirinox, 6 cycles