Neoadjuvant therapy of rectal cancer

Neoadjuvant Therapy in Rectal Cancer

Mohamed Abdulla MD

Prof of Clinical Oncology

Cairo University

Colorectal Cancer MeetingZagazig 06042017

Member of Advisory Board Consultant and Speaker for

bull Amgen Astellas AstraZeneca Hoffman la Roche Janssen Cilag Merck Serono Novartis Pfizer Mundipharma

bull The content of this presentation does not relate to any product of a commercial interest

Speaker Disclosures

Basic Facts

bull 2nd amp 3rd most common cancer in females amp males

bull 14 million new case and 694000 deaths

bull Males gt Females

bull Lowest rates in Africa amp South Central Asia

bull Low SES 30 increased risk

bull Rising incidence lt 50 years Left sided colon amp rectal symptomatic amp advanced Poor outcome yet better than right sided colon cancer

bull Sporadic gt Hereditary

Siegel RL Miller KD Jemal A Cancer statistics 2016 CA Cancer J Clin 2016 667 Ahnen DJ Wade SW Jones WF et al The increasing incidence of young-onset colorectal cancer a call to action Mayo Clin Proc2014 89216

Principles

Surgery is the cornerstone in management

However

Local Recurrence Following Surgery Alone

Clinical Colorectal Cancer Vol 4 No 4 233-240 2004

Adjuvant Radiation Therapy


Cuthbert Dukes 1932 Nodes as a prognostic factor

Local Recurrence Better Insight

CircumferentialMargins

Number Local Recurrence Rate

P

gt 2 mm 987 33 lt 00001

1 ndash 2 mm 100 85 002

lt 1 mm 227 131 008

Int J Radiation Oncology Biol Phys Vol 55 No 5 pp 1311ndash1320 2003

CRM or LNs

MURCERY Trial

Fiona et al JCO 20141(32) 34-46

Accuracy in staging early rectal cancer

Presented By Julio Garcia-Aguilar at 2017 Gastrointestinal Cancers Symposium

Limitations of the TNM ndash T3 category forms 80 of rectal cancers

Total Mesorectal Excision (TME)

bull Removal of peri-rectaltissues involving lateral ampcircumferential margins ofmesorectal envelop

Dis Colon Rectum 2013 May56(5)535-50


Clinical Colorectal Cancer Vol 4 No 4 233-240 2004N Engl J Med 2001345638 ndash 646


LR = 24

Adjuvant Chemoradiation in Stages II amp III Rectal Cancer

bull GITSG

bull NCCTG

bull NSABP R-01

N Engl J Med 1986 3151294FJ Natl Cancer Inst 1988 8021 N Engl J Med 1991 324709

Adjuvant Fluoroupyremidine

X 2 monthsCRT ndash 6 Weeks


X 2 months

Adjuvant Therapy = 6 months

Neoadjuvant Therapy The German Study A Shifting Concept

N Engl J Med 20043511731-40

Slide 4

Slide 3

Slide 2

Slide 6

Slide 7

Slide 9

Slide 11

Slide 12

Radiation + Chemotherapy are MANDATORY in Neoadjuvant Therapy

Gastrointest Cancer Res 149-56 copy2007 by International Society of Gastrointestinal Oncology

Neoadjuvant TherapyThe Use of Capecitabine

The Cancer Journal bull Volume 13 Number 3 MayJune 2007

EQUIVALENT

Neoadjuvant TherapyAdding Oxaliplatin

Curr Opin Oncol 2012 24441ndash447

bull ++ Toxicity amp -- Compliancebull Did not improve

1 R0 RR2 pCR3 Sphincter Preservation

The PETACC-6 RCTltbr gt


ltbr gtPETACC-6 ltbr gtEarly analysis at 31 months shows no major differences between armsltbr gt


Neoadjuvant TherapyAdding EGFR Inhibition


Neoadjuvant TherapyAdding VEGF Inhibition


Neoadjuvant TherapyAdding EGFRVEGF Inhibition


No Significant Added Benefit over Chemotherapy amp Higher G 3 amp 4

Adverse Events

Neoadjuvant TherapyIndications

1 T3 ndash T4 Lesions The only definitive indication

2 cT3N0 Should be treated (understaging)

3 Depth of Extramural Invasionndash T3 lesions (gt5 mm) ++ LNs involvement Higher

Cancer Specific Mortality (54 Versus 85)

ndash Selection of high risk T3 for treatment

ndash Approved outside US

4 T1 ndash 2 lesions with Positive Nodes

5 Low situated lesions

6 Invasion of mesorectal fascia

Br J Cancer 2000 821131wwwuptodatecom (September 2015)

Neoadjuvant TherapyTreatment Outcome

Complete Response

cCRpCR

bull 15 ndash 30bull Small amp Less

Advanced Lesionsbull 10 ndash 12 Weeks

bull Involution to flat scarbull DRE amp Endoscopybull Imaging

bull Endorectal USbull PET-CTbull MRI

bull ypT0N0

Martin R et al Surg Oncol Clin N Am 23 (2014) 113ndash125

Neoadjuvant TherapyTreatment Outcome in Relation to pCR German Study

Grade Regression Fibrosis

0 No All cells are viable

1 Minor lt 25 fibrosis

2 Moderate 26 ndash 50nFibrosis

3 Good gt50

4 Total No Viable Cells

Neoadjuvant TherapyTumor Regression Grade

Grade 10 ndash year DM

P 10 ndash Year DFS P

0 - 1 3960005

6300082 - 3 293 736

4 105 895

J Clin Oncol 321554-1562 copy 2014

Neoadjuvant TherapyImpact of Pathological CR

British Journal of Surgery 2012 99 918ndash928

Can we Avoid Surgery



JCO VOLUME 29 1113097 NUMBER 35 1113097 DECEMBER 10 2011

21 PatientspCR

Neoadjuvant CRTFor Stages II amp III

Wait amp See

MRI Endoscopy amp Biopsy

Median Follow up =25 months

1 Patient LR Surgery

20 Pts Stages II amp III NAT pCR


2 ndash Year DFS 91 2 ndash Year OAS 93

The International Watch amp Wait Database (IWWD) for Rectal Cancer

Presented By Maxime Valk at 2017 Gastrointestinal Cancers Symposium

Watch amp Wait in Rectal Cancer




Slide 10


Slide 11


Slide 13


Slide 14


Slide 15


Slide 16


Cause of death


Cause of death


Take home messages


Adjuvant Therapy in Rectal CancerMandatory or Not

The Cochrane Review Metanalysis Demonstrates DFS Adjuvant Treatment Benefit

Impact of Adjuvant Therapy on DFS

The Cochrane Review Metanalysis Demonstrates OS Adjuvant Treatment Benefit

Impact of Adjuvant Therapy on OAS

Postop Adjuvant 5FU or FOLFOX for Rectal Cancer The ADORE Trial Randomized Phase II ltbr gt

ltbr gtGerman CAOAROAIO-04 Studyltbr gtAdjuvant FOLFOX has better DFS not OS than 5FU after pre-op ChemoRT

bull Adjuvant Chemotherapy

bull Oxaliplatin ndash Based

Rectal Cancer

Problems with Adjuvant Chemotherapy

Modern Adjuvant Chemotherapy Rectal Trials

bull EORTC 22921 (Bosset Lancet Oncology 2014)

bull Italian (Sainato Radiother Oncol 2014)

bull Chronicle (Glynne Jones Ann Oncol 2014)

bull PROCTORSCRIPT (Bregoum Ann Oncol 2014)

Meta-analyses NOT POSITIVE

bull Bregoum (Lancet Oncol 2015)

bull Bujiko (EJSO 2015)

NEG

ATI

VE

Parameter HR P

OAS 097 0775

DFS 091 0230

Distant Recurrence 094 0523

Problems with Adjuvant Chemotherapybull 4 Major Trials 1198 Patientsbull All received preoperative therapiesbull Overall No Gain even

Parameter HR P

DFS 059 0005


bull Rectal Tumors 10 ndash 15 cm above AV

Bregoum et al Lancet Oncol 2015 16 200ndash07

bull No one can indicate not to be given

bull To add CRT if not received before and risk of LR is high

bull Only patients with preoperative CRT and low risk of Recurrence can be spared

bull Data are extrapolated from colon cancer Oxaliplatin based therapy

bull Impact of pCR

Adjuvant ChemotherapyPragmatic Conclusions

As Presented by Glimelius in ASCO GI 2016

Neoadjuvant TherapyProblems with Current PracticeCRT

55 Weeks 6 wksTME

1 ndash 2 weeks4-6 wks Adjuvant Cth

18 weeksbull Delayedbull Reducedbull Omitted

CRT TME Neodjuvant Chemoth

Neodjuvant Chemoth

CRT TME

Adopted from Deborah Schragrsquos Presentation at 2015 ASCO Annual Meeting

Total Neoadjuvant ParadigmBrown University Study (CONTRE)

FOLFOX X 8 Courses

CRT + Cape TME

Pathologic Grade

Total Number Stage II Stage III

38 7 31

0 (Complete) 13 1 12

1 14 4 10

2 8 1 7

3 3 1 2

bull 35 Pts Completed Treatmentbull pCR = 33

Perez et al ASCO 2014 Abstract 3050

Slide 12

Near total neoadjuvant therapy

Questions Total Neoadjuvant YesNoAdjuvant Cth YesNoLong versus Short Course

PROSPECT N1048 is ongoingltbr gtSelective Use of Pelvic XRTltbr gt

Can we Omit Radiation From NAT

MSKCC 07-021 Phase II Trial of Selective Radiation for Rectal Cancer


[TITLE]

[TITLE]

The Art for Today

bull Clinical Trial whenever possiblebull Careful assessmentbull Chemosensitization by 5-FU or Capecitabine is

enoughbull Upfront chemotherapy is appealing Total amp

Near Total NAT should be encourgaed pCRbull TME IS THE STANDARD SURGICAL APPROACH

(STAGES II amp III)bull Postoperative chemotherapy should be discussed

and considered for high risk patients DFS

Thank You

Member of Advisory Board Consultant and Speaker for

bull Amgen Astellas AstraZeneca Hoffman la Roche Janssen Cilag Merck Serono Novartis Pfizer Mundipharma

bull The content of this presentation does not relate to any product of a commercial interest

Speaker Disclosures

Basic Facts









Principles


However









P

gt 2 mm 987 33 lt 00001

1 ndash 2 mm 100 85 002

lt 1 mm 227 131 008


CRM or LNs

MURCERY Trial

Fiona et al JCO 20141(32) 34-46










LR = 24


bull GITSG

bull NCCTG

bull NSABP R-01





X 2 months



N Engl J Med 20043511731-40

Slide 4

Slide 3

Slide 2

Slide 6

Slide 7

Slide 9

Slide 11

Slide 12





EQUIVALENT
















Adverse Events













Complete Response

cCRpCR





bull ypT0N0







3 Good gt50





0 - 1 3960005

6300082 - 3 293 736

4 105 895








21 PatientspCR


Wait amp See













Slide 10


Slide 11


Slide 13


Slide 14


Slide 15


Slide 16


Cause of death


Cause of death


Take home messages











Rectal Cancer










NEG

ATI

VE

Parameter HR P

OAS 097 0775

DFS 091 0230



Parameter HR P

DFS 059 0005








bull Impact of pCR




55 Weeks 6 wksTME




Neodjuvant Chemoth

CRT TME



FOLFOX X 8 Courses

CRT + Cape TME

Pathologic Grade


38 7 31


1 14 4 10

2 8 1 7

3 3 1 2



Slide 12







[TITLE]

[TITLE]

The Art for Today






Thank You

Basic Facts









Principles


However









P

gt 2 mm 987 33 lt 00001

1 ndash 2 mm 100 85 002

lt 1 mm 227 131 008


CRM or LNs

MURCERY Trial

Fiona et al JCO 20141(32) 34-46










LR = 24


bull GITSG

bull NCCTG

bull NSABP R-01





X 2 months



N Engl J Med 20043511731-40

Slide 4

Slide 3

Slide 2

Slide 6

Slide 7

Slide 9

Slide 11

Slide 12





EQUIVALENT
















Adverse Events













Complete Response

cCRpCR





bull ypT0N0







3 Good gt50





0 - 1 3960005

6300082 - 3 293 736

4 105 895








21 PatientspCR


Wait amp See













Slide 10


Slide 11


Slide 13


Slide 14


Slide 15


Slide 16


Cause of death


Cause of death


Take home messages











Rectal Cancer










NEG

ATI

VE

Parameter HR P

OAS 097 0775

DFS 091 0230



Parameter HR P

DFS 059 0005








bull Impact of pCR




55 Weeks 6 wksTME




Neodjuvant Chemoth

CRT TME



FOLFOX X 8 Courses

CRT + Cape TME

Pathologic Grade


38 7 31


1 14 4 10

2 8 1 7

3 3 1 2



Slide 12







[TITLE]

[TITLE]

The Art for Today






Thank You

Principles


However









P

gt 2 mm 987 33 lt 00001

1 ndash 2 mm 100 85 002

lt 1 mm 227 131 008


CRM or LNs

MURCERY Trial

Fiona et al JCO 20141(32) 34-46










LR = 24


bull GITSG

bull NCCTG

bull NSABP R-01





X 2 months



N Engl J Med 20043511731-40

Slide 4

Slide 3

Slide 2

Slide 6

Slide 7

Slide 9

Slide 11

Slide 12





EQUIVALENT
















Adverse Events













Complete Response

cCRpCR





bull ypT0N0







3 Good gt50





0 - 1 3960005

6300082 - 3 293 736

4 105 895








21 PatientspCR


Wait amp See













Slide 10


Slide 11


Slide 13


Slide 14


Slide 15


Slide 16


Cause of death


Cause of death


Take home messages











Rectal Cancer










NEG

ATI

VE

Parameter HR P

OAS 097 0775

DFS 091 0230



Parameter HR P

DFS 059 0005








bull Impact of pCR




55 Weeks 6 wksTME




Neodjuvant Chemoth

CRT TME



FOLFOX X 8 Courses

CRT + Cape TME

Pathologic Grade


38 7 31


1 14 4 10

2 8 1 7

3 3 1 2



Slide 12







[TITLE]

[TITLE]

The Art for Today






Thank You









P

gt 2 mm 987 33 lt 00001

1 ndash 2 mm 100 85 002

lt 1 mm 227 131 008


CRM or LNs

MURCERY Trial

Fiona et al JCO 20141(32) 34-46










LR = 24


bull GITSG

bull NCCTG

bull NSABP R-01





X 2 months



N Engl J Med 20043511731-40

Slide 4

Slide 3

Slide 2

Slide 6

Slide 7

Slide 9

Slide 11

Slide 12





EQUIVALENT
















Adverse Events













Complete Response

cCRpCR





bull ypT0N0







3 Good gt50





0 - 1 3960005

6300082 - 3 293 736

4 105 895








21 PatientspCR


Wait amp See













Slide 10


Slide 11


Slide 13


Slide 14


Slide 15


Slide 16


Cause of death


Cause of death


Take home messages











Rectal Cancer










NEG

ATI

VE

Parameter HR P

OAS 097 0775

DFS 091 0230



Parameter HR P

DFS 059 0005








bull Impact of pCR




55 Weeks 6 wksTME




Neodjuvant Chemoth

CRT TME



FOLFOX X 8 Courses

CRT + Cape TME

Pathologic Grade


38 7 31


1 14 4 10

2 8 1 7

3 3 1 2



Slide 12







[TITLE]

[TITLE]

The Art for Today






Thank You







P

gt 2 mm 987 33 lt 00001

1 ndash 2 mm 100 85 002

lt 1 mm 227 131 008


CRM or LNs

MURCERY Trial

Fiona et al JCO 20141(32) 34-46










LR = 24


bull GITSG

bull NCCTG

bull NSABP R-01





X 2 months



N Engl J Med 20043511731-40

Slide 4

Slide 3

Slide 2

Slide 6

Slide 7

Slide 9

Slide 11

Slide 12





EQUIVALENT
















Adverse Events













Complete Response

cCRpCR





bull ypT0N0







3 Good gt50





0 - 1 3960005

6300082 - 3 293 736

4 105 895








21 PatientspCR


Wait amp See













Slide 10


Slide 11


Slide 13


Slide 14


Slide 15


Slide 16


Cause of death


Cause of death


Take home messages











Rectal Cancer










NEG

ATI

VE

Parameter HR P

OAS 097 0775

DFS 091 0230



Parameter HR P

DFS 059 0005








bull Impact of pCR




55 Weeks 6 wksTME




Neodjuvant Chemoth

CRT TME



FOLFOX X 8 Courses

CRT + Cape TME

Pathologic Grade


38 7 31


1 14 4 10

2 8 1 7

3 3 1 2



Slide 12







[TITLE]

[TITLE]

The Art for Today






Thank You





P

gt 2 mm 987 33 lt 00001

1 ndash 2 mm 100 85 002

lt 1 mm 227 131 008


CRM or LNs

MURCERY Trial

Fiona et al JCO 20141(32) 34-46










LR = 24


bull GITSG

bull NCCTG

bull NSABP R-01





X 2 months



N Engl J Med 20043511731-40

Slide 4

Slide 3

Slide 2

Slide 6

Slide 7

Slide 9

Slide 11

Slide 12





EQUIVALENT
















Adverse Events













Complete Response

cCRpCR





bull ypT0N0







3 Good gt50





0 - 1 3960005

6300082 - 3 293 736

4 105 895








21 PatientspCR


Wait amp See













Slide 10


Slide 11


Slide 13


Slide 14


Slide 15


Slide 16


Cause of death


Cause of death


Take home messages











Rectal Cancer










NEG

ATI

VE

Parameter HR P

OAS 097 0775

DFS 091 0230



Parameter HR P

DFS 059 0005








bull Impact of pCR




55 Weeks 6 wksTME




Neodjuvant Chemoth

CRT TME



FOLFOX X 8 Courses

CRT + Cape TME

Pathologic Grade


38 7 31


1 14 4 10

2 8 1 7

3 3 1 2



Slide 12







[TITLE]

[TITLE]

The Art for Today






Thank You




P

gt 2 mm 987 33 lt 00001

1 ndash 2 mm 100 85 002

lt 1 mm 227 131 008


CRM or LNs

MURCERY Trial

Fiona et al JCO 20141(32) 34-46










LR = 24


bull GITSG

bull NCCTG

bull NSABP R-01





X 2 months



N Engl J Med 20043511731-40

Slide 4

Slide 3

Slide 2

Slide 6

Slide 7

Slide 9

Slide 11

Slide 12





EQUIVALENT
















Adverse Events













Complete Response

cCRpCR





bull ypT0N0







3 Good gt50





0 - 1 3960005

6300082 - 3 293 736

4 105 895








21 PatientspCR


Wait amp See













Slide 10


Slide 11


Slide 13


Slide 14


Slide 15


Slide 16


Cause of death


Cause of death


Take home messages











Rectal Cancer










NEG

ATI

VE

Parameter HR P

OAS 097 0775

DFS 091 0230



Parameter HR P

DFS 059 0005








bull Impact of pCR




55 Weeks 6 wksTME




Neodjuvant Chemoth

CRT TME



FOLFOX X 8 Courses

CRT + Cape TME

Pathologic Grade


38 7 31


1 14 4 10

2 8 1 7

3 3 1 2



Slide 12







[TITLE]

[TITLE]

The Art for Today






Thank You

CRM or LNs

MURCERY Trial

Fiona et al JCO 20141(32) 34-46










LR = 24


bull GITSG

bull NCCTG

bull NSABP R-01





X 2 months



N Engl J Med 20043511731-40

Slide 4

Slide 3

Slide 2

Slide 6

Slide 7

Slide 9

Slide 11

Slide 12





EQUIVALENT
















Adverse Events













Complete Response

cCRpCR





bull ypT0N0







3 Good gt50





0 - 1 3960005

6300082 - 3 293 736

4 105 895








21 PatientspCR


Wait amp See













Slide 10


Slide 11


Slide 13


Slide 14


Slide 15


Slide 16


Cause of death


Cause of death


Take home messages











Rectal Cancer










NEG

ATI

VE

Parameter HR P

OAS 097 0775

DFS 091 0230



Parameter HR P

DFS 059 0005








bull Impact of pCR




55 Weeks 6 wksTME




Neodjuvant Chemoth

CRT TME



FOLFOX X 8 Courses

CRT + Cape TME

Pathologic Grade


38 7 31


1 14 4 10

2 8 1 7

3 3 1 2



Slide 12







[TITLE]

[TITLE]

The Art for Today






Thank You

MURCERY Trial

Fiona et al JCO 20141(32) 34-46










LR = 24


bull GITSG

bull NCCTG

bull NSABP R-01





X 2 months



N Engl J Med 20043511731-40

Slide 4

Slide 3

Slide 2

Slide 6

Slide 7

Slide 9

Slide 11

Slide 12





EQUIVALENT
















Adverse Events













Complete Response

cCRpCR





bull ypT0N0







3 Good gt50





0 - 1 3960005

6300082 - 3 293 736

4 105 895








21 PatientspCR


Wait amp See













Slide 10


Slide 11


Slide 13


Slide 14


Slide 15


Slide 16


Cause of death


Cause of death


Take home messages











Rectal Cancer










NEG

ATI

VE

Parameter HR P

OAS 097 0775

DFS 091 0230



Parameter HR P

DFS 059 0005








bull Impact of pCR




55 Weeks 6 wksTME




Neodjuvant Chemoth

CRT TME



FOLFOX X 8 Courses

CRT + Cape TME

Pathologic Grade


38 7 31


1 14 4 10

2 8 1 7

3 3 1 2



Slide 12







[TITLE]

[TITLE]

The Art for Today






Thank You










LR = 24


bull GITSG

bull NCCTG

bull NSABP R-01





X 2 months



N Engl J Med 20043511731-40

Slide 4

Slide 3

Slide 2

Slide 6

Slide 7

Slide 9

Slide 11

Slide 12





EQUIVALENT
















Adverse Events













Complete Response

cCRpCR





bull ypT0N0







3 Good gt50





0 - 1 3960005

6300082 - 3 293 736

4 105 895








21 PatientspCR


Wait amp See













Slide 10


Slide 11


Slide 13


Slide 14


Slide 15


Slide 16


Cause of death


Cause of death


Take home messages











Rectal Cancer










NEG

ATI

VE

Parameter HR P

OAS 097 0775

DFS 091 0230



Parameter HR P

DFS 059 0005








bull Impact of pCR




55 Weeks 6 wksTME




Neodjuvant Chemoth

CRT TME



FOLFOX X 8 Courses

CRT + Cape TME

Pathologic Grade


38 7 31


1 14 4 10

2 8 1 7

3 3 1 2



Slide 12







[TITLE]

[TITLE]

The Art for Today






Thank You








LR = 24


bull GITSG

bull NCCTG

bull NSABP R-01





X 2 months



N Engl J Med 20043511731-40

Slide 4

Slide 3

Slide 2

Slide 6

Slide 7

Slide 9

Slide 11

Slide 12





EQUIVALENT
















Adverse Events













Complete Response

cCRpCR





bull ypT0N0







3 Good gt50





0 - 1 3960005

6300082 - 3 293 736

4 105 895








21 PatientspCR


Wait amp See













Slide 10


Slide 11


Slide 13


Slide 14


Slide 15


Slide 16


Cause of death


Cause of death


Take home messages











Rectal Cancer










NEG

ATI

VE

Parameter HR P

OAS 097 0775

DFS 091 0230



Parameter HR P

DFS 059 0005








bull Impact of pCR




55 Weeks 6 wksTME




Neodjuvant Chemoth

CRT TME



FOLFOX X 8 Courses

CRT + Cape TME

Pathologic Grade


38 7 31


1 14 4 10

2 8 1 7

3 3 1 2



Slide 12







[TITLE]

[TITLE]

The Art for Today






Thank You







LR = 24


bull GITSG

bull NCCTG

bull NSABP R-01





X 2 months



N Engl J Med 20043511731-40

Slide 4

Slide 3

Slide 2

Slide 6

Slide 7

Slide 9

Slide 11

Slide 12





EQUIVALENT
















Adverse Events













Complete Response

cCRpCR





bull ypT0N0







3 Good gt50





0 - 1 3960005

6300082 - 3 293 736

4 105 895








21 PatientspCR


Wait amp See













Slide 10


Slide 11


Slide 13


Slide 14


Slide 15


Slide 16


Cause of death


Cause of death


Take home messages











Rectal Cancer










NEG

ATI

VE

Parameter HR P

OAS 097 0775

DFS 091 0230



Parameter HR P

DFS 059 0005








bull Impact of pCR




55 Weeks 6 wksTME




Neodjuvant Chemoth

CRT TME



FOLFOX X 8 Courses

CRT + Cape TME

Pathologic Grade


38 7 31


1 14 4 10

2 8 1 7

3 3 1 2



Slide 12







[TITLE]

[TITLE]

The Art for Today






Thank You




LR = 24


bull GITSG

bull NCCTG

bull NSABP R-01





X 2 months



N Engl J Med 20043511731-40

Slide 4

Slide 3

Slide 2

Slide 6

Slide 7

Slide 9

Slide 11

Slide 12





EQUIVALENT
















Adverse Events













Complete Response

cCRpCR





bull ypT0N0







3 Good gt50





0 - 1 3960005

6300082 - 3 293 736

4 105 895








21 PatientspCR


Wait amp See













Slide 10


Slide 11


Slide 13


Slide 14


Slide 15


Slide 16


Cause of death


Cause of death


Take home messages











Rectal Cancer










NEG

ATI

VE

Parameter HR P

OAS 097 0775

DFS 091 0230



Parameter HR P

DFS 059 0005








bull Impact of pCR




55 Weeks 6 wksTME




Neodjuvant Chemoth

CRT TME



FOLFOX X 8 Courses

CRT + Cape TME

Pathologic Grade


38 7 31


1 14 4 10

2 8 1 7

3 3 1 2



Slide 12







[TITLE]

[TITLE]

The Art for Today






Thank You


bull GITSG

bull NCCTG

bull NSABP R-01





X 2 months



N Engl J Med 20043511731-40

Slide 4

Slide 3

Slide 2

Slide 6

Slide 7

Slide 9

Slide 11

Slide 12





EQUIVALENT
















Adverse Events













Complete Response

cCRpCR





bull ypT0N0







3 Good gt50





0 - 1 3960005

6300082 - 3 293 736

4 105 895








21 PatientspCR


Wait amp See













Slide 10


Slide 11


Slide 13


Slide 14


Slide 15


Slide 16


Cause of death


Cause of death


Take home messages











Rectal Cancer










NEG

ATI

VE

Parameter HR P

OAS 097 0775

DFS 091 0230



Parameter HR P

DFS 059 0005








bull Impact of pCR




55 Weeks 6 wksTME




Neodjuvant Chemoth

CRT TME



FOLFOX X 8 Courses

CRT + Cape TME

Pathologic Grade


38 7 31


1 14 4 10

2 8 1 7

3 3 1 2



Slide 12







[TITLE]

[TITLE]

The Art for Today






Thank You


N Engl J Med 20043511731-40

Slide 4

Slide 3

Slide 2

Slide 6

Slide 7

Slide 9

Slide 11

Slide 12





EQUIVALENT
















Adverse Events













Complete Response

cCRpCR





bull ypT0N0







3 Good gt50





0 - 1 3960005

6300082 - 3 293 736

4 105 895








21 PatientspCR


Wait amp See













Slide 10


Slide 11


Slide 13


Slide 14


Slide 15


Slide 16


Cause of death


Cause of death


Take home messages











Rectal Cancer










NEG

ATI

VE

Parameter HR P

OAS 097 0775

DFS 091 0230



Parameter HR P

DFS 059 0005








bull Impact of pCR




55 Weeks 6 wksTME




Neodjuvant Chemoth

CRT TME



FOLFOX X 8 Courses

CRT + Cape TME

Pathologic Grade


38 7 31


1 14 4 10

2 8 1 7

3 3 1 2



Slide 12







[TITLE]

[TITLE]

The Art for Today






Thank You

Slide 4

Slide 3

Slide 2

Slide 6

Slide 7

Slide 9

Slide 11

Slide 12





EQUIVALENT
















Adverse Events













Complete Response

cCRpCR





bull ypT0N0







3 Good gt50





0 - 1 3960005

6300082 - 3 293 736

4 105 895








21 PatientspCR


Wait amp See













Slide 10


Slide 11


Slide 13


Slide 14


Slide 15


Slide 16


Cause of death


Cause of death


Take home messages











Rectal Cancer










NEG

ATI

VE

Parameter HR P

OAS 097 0775

DFS 091 0230



Parameter HR P

DFS 059 0005








bull Impact of pCR




55 Weeks 6 wksTME




Neodjuvant Chemoth

CRT TME



FOLFOX X 8 Courses

CRT + Cape TME

Pathologic Grade


38 7 31


1 14 4 10

2 8 1 7

3 3 1 2



Slide 12







[TITLE]

[TITLE]

The Art for Today






Thank You

Slide 3

Slide 2

Slide 6

Slide 7

Slide 9

Slide 11

Slide 12





EQUIVALENT
















Adverse Events













Complete Response

cCRpCR





bull ypT0N0







3 Good gt50





0 - 1 3960005

6300082 - 3 293 736

4 105 895








21 PatientspCR


Wait amp See













Slide 10


Slide 11


Slide 13


Slide 14


Slide 15


Slide 16


Cause of death


Cause of death


Take home messages











Rectal Cancer










NEG

ATI

VE

Parameter HR P

OAS 097 0775

DFS 091 0230



Parameter HR P

DFS 059 0005








bull Impact of pCR




55 Weeks 6 wksTME




Neodjuvant Chemoth

CRT TME



FOLFOX X 8 Courses

CRT + Cape TME

Pathologic Grade


38 7 31


1 14 4 10

2 8 1 7

3 3 1 2



Slide 12







[TITLE]

[TITLE]

The Art for Today






Thank You

Slide 2

Slide 6

Slide 7

Slide 9

Slide 11

Slide 12





EQUIVALENT
















Adverse Events













Complete Response

cCRpCR





bull ypT0N0







3 Good gt50





0 - 1 3960005

6300082 - 3 293 736

4 105 895








21 PatientspCR


Wait amp See













Slide 10


Slide 11


Slide 13


Slide 14


Slide 15


Slide 16


Cause of death


Cause of death


Take home messages











Rectal Cancer










NEG

ATI

VE

Parameter HR P

OAS 097 0775

DFS 091 0230



Parameter HR P

DFS 059 0005








bull Impact of pCR




55 Weeks 6 wksTME




Neodjuvant Chemoth

CRT TME



FOLFOX X 8 Courses

CRT + Cape TME

Pathologic Grade


38 7 31


1 14 4 10

2 8 1 7

3 3 1 2



Slide 12







[TITLE]

[TITLE]

The Art for Today






Thank You

Slide 6

Slide 7

Slide 9

Slide 11

Slide 12





EQUIVALENT
















Adverse Events













Complete Response

cCRpCR





bull ypT0N0







3 Good gt50





0 - 1 3960005

6300082 - 3 293 736

4 105 895








21 PatientspCR


Wait amp See













Slide 10


Slide 11


Slide 13


Slide 14


Slide 15


Slide 16


Cause of death


Cause of death


Take home messages











Rectal Cancer










NEG

ATI

VE

Parameter HR P

OAS 097 0775

DFS 091 0230



Parameter HR P

DFS 059 0005








bull Impact of pCR




55 Weeks 6 wksTME




Neodjuvant Chemoth

CRT TME



FOLFOX X 8 Courses

CRT + Cape TME

Pathologic Grade


38 7 31


1 14 4 10

2 8 1 7

3 3 1 2



Slide 12







[TITLE]

[TITLE]

The Art for Today






Thank You

Slide 7

Slide 9

Slide 11

Slide 12





EQUIVALENT
















Adverse Events













Complete Response

cCRpCR





bull ypT0N0







3 Good gt50





0 - 1 3960005

6300082 - 3 293 736

4 105 895








21 PatientspCR


Wait amp See













Slide 10


Slide 11


Slide 13


Slide 14


Slide 15


Slide 16


Cause of death


Cause of death


Take home messages











Rectal Cancer










NEG

ATI

VE

Parameter HR P

OAS 097 0775

DFS 091 0230



Parameter HR P

DFS 059 0005








bull Impact of pCR




55 Weeks 6 wksTME




Neodjuvant Chemoth

CRT TME



FOLFOX X 8 Courses

CRT + Cape TME

Pathologic Grade


38 7 31


1 14 4 10

2 8 1 7

3 3 1 2



Slide 12







[TITLE]

[TITLE]

The Art for Today






Thank You

Slide 9

Slide 11

Slide 12





EQUIVALENT
















Adverse Events













Complete Response

cCRpCR





bull ypT0N0







3 Good gt50





0 - 1 3960005

6300082 - 3 293 736

4 105 895








21 PatientspCR


Wait amp See













Slide 10


Slide 11


Slide 13


Slide 14


Slide 15


Slide 16


Cause of death


Cause of death


Take home messages











Rectal Cancer










NEG

ATI

VE

Parameter HR P

OAS 097 0775

DFS 091 0230



Parameter HR P

DFS 059 0005








bull Impact of pCR




55 Weeks 6 wksTME




Neodjuvant Chemoth

CRT TME



FOLFOX X 8 Courses

CRT + Cape TME

Pathologic Grade


38 7 31


1 14 4 10

2 8 1 7

3 3 1 2



Slide 12







[TITLE]

[TITLE]

The Art for Today






Thank You

Slide 11

Slide 12





EQUIVALENT
















Adverse Events













Complete Response

cCRpCR





bull ypT0N0







3 Good gt50





0 - 1 3960005

6300082 - 3 293 736

4 105 895








21 PatientspCR


Wait amp See













Slide 10


Slide 11


Slide 13


Slide 14


Slide 15


Slide 16


Cause of death


Cause of death


Take home messages











Rectal Cancer










NEG

ATI

VE

Parameter HR P

OAS 097 0775

DFS 091 0230



Parameter HR P

DFS 059 0005








bull Impact of pCR




55 Weeks 6 wksTME




Neodjuvant Chemoth

CRT TME



FOLFOX X 8 Courses

CRT + Cape TME

Pathologic Grade


38 7 31


1 14 4 10

2 8 1 7

3 3 1 2



Slide 12







[TITLE]

[TITLE]

The Art for Today






Thank You

Slide 12





EQUIVALENT
















Adverse Events













Complete Response

cCRpCR





bull ypT0N0







3 Good gt50





0 - 1 3960005

6300082 - 3 293 736

4 105 895








21 PatientspCR


Wait amp See













Slide 10


Slide 11


Slide 13


Slide 14


Slide 15


Slide 16


Cause of death


Cause of death


Take home messages











Rectal Cancer










NEG

ATI

VE

Parameter HR P

OAS 097 0775

DFS 091 0230



Parameter HR P

DFS 059 0005








bull Impact of pCR




55 Weeks 6 wksTME




Neodjuvant Chemoth

CRT TME



FOLFOX X 8 Courses

CRT + Cape TME

Pathologic Grade


38 7 31


1 14 4 10

2 8 1 7

3 3 1 2



Slide 12







[TITLE]

[TITLE]

The Art for Today






Thank You





EQUIVALENT
















Adverse Events













Complete Response

cCRpCR





bull ypT0N0







3 Good gt50





0 - 1 3960005

6300082 - 3 293 736

4 105 895








21 PatientspCR


Wait amp See













Slide 10


Slide 11


Slide 13


Slide 14


Slide 15


Slide 16


Cause of death


Cause of death


Take home messages











Rectal Cancer










NEG

ATI

VE

Parameter HR P

OAS 097 0775

DFS 091 0230



Parameter HR P

DFS 059 0005








bull Impact of pCR




55 Weeks 6 wksTME




Neodjuvant Chemoth

CRT TME



FOLFOX X 8 Courses

CRT + Cape TME

Pathologic Grade


38 7 31


1 14 4 10

2 8 1 7

3 3 1 2



Slide 12







[TITLE]

[TITLE]

The Art for Today






Thank You



EQUIVALENT
















Adverse Events













Complete Response

cCRpCR





bull ypT0N0







3 Good gt50





0 - 1 3960005

6300082 - 3 293 736

4 105 895








21 PatientspCR


Wait amp See













Slide 10


Slide 11


Slide 13


Slide 14


Slide 15


Slide 16


Cause of death


Cause of death


Take home messages











Rectal Cancer










NEG

ATI

VE

Parameter HR P

OAS 097 0775

DFS 091 0230



Parameter HR P

DFS 059 0005








bull Impact of pCR




55 Weeks 6 wksTME




Neodjuvant Chemoth

CRT TME



FOLFOX X 8 Courses

CRT + Cape TME

Pathologic Grade


38 7 31


1 14 4 10

2 8 1 7

3 3 1 2



Slide 12







[TITLE]

[TITLE]

The Art for Today






Thank You
















Adverse Events













Complete Response

cCRpCR





bull ypT0N0







3 Good gt50





0 - 1 3960005

6300082 - 3 293 736

4 105 895








21 PatientspCR


Wait amp See













Slide 10


Slide 11


Slide 13


Slide 14


Slide 15


Slide 16


Cause of death


Cause of death


Take home messages











Rectal Cancer










NEG

ATI

VE

Parameter HR P

OAS 097 0775

DFS 091 0230



Parameter HR P

DFS 059 0005








bull Impact of pCR




55 Weeks 6 wksTME




Neodjuvant Chemoth

CRT TME



FOLFOX X 8 Courses

CRT + Cape TME

Pathologic Grade


38 7 31


1 14 4 10

2 8 1 7

3 3 1 2



Slide 12







[TITLE]

[TITLE]

The Art for Today






Thank You












Adverse Events













Complete Response

cCRpCR





bull ypT0N0







3 Good gt50





0 - 1 3960005

6300082 - 3 293 736

4 105 895








21 PatientspCR


Wait amp See













Slide 10


Slide 11


Slide 13


Slide 14


Slide 15


Slide 16


Cause of death


Cause of death


Take home messages











Rectal Cancer










NEG

ATI

VE

Parameter HR P

OAS 097 0775

DFS 091 0230



Parameter HR P

DFS 059 0005








bull Impact of pCR




55 Weeks 6 wksTME




Neodjuvant Chemoth

CRT TME



FOLFOX X 8 Courses

CRT + Cape TME

Pathologic Grade


38 7 31


1 14 4 10

2 8 1 7

3 3 1 2



Slide 12







[TITLE]

[TITLE]

The Art for Today






Thank You










Adverse Events













Complete Response

cCRpCR





bull ypT0N0







3 Good gt50





0 - 1 3960005

6300082 - 3 293 736

4 105 895








21 PatientspCR


Wait amp See













Slide 10


Slide 11


Slide 13


Slide 14


Slide 15


Slide 16


Cause of death


Cause of death


Take home messages











Rectal Cancer










NEG

ATI

VE

Parameter HR P

OAS 097 0775

DFS 091 0230



Parameter HR P

DFS 059 0005








bull Impact of pCR




55 Weeks 6 wksTME




Neodjuvant Chemoth

CRT TME



FOLFOX X 8 Courses

CRT + Cape TME

Pathologic Grade


38 7 31


1 14 4 10

2 8 1 7

3 3 1 2



Slide 12







[TITLE]

[TITLE]

The Art for Today






Thank You








Adverse Events













Complete Response

cCRpCR





bull ypT0N0







3 Good gt50





0 - 1 3960005

6300082 - 3 293 736

4 105 895








21 PatientspCR


Wait amp See













Slide 10


Slide 11


Slide 13


Slide 14


Slide 15


Slide 16


Cause of death


Cause of death


Take home messages











Rectal Cancer










NEG

ATI

VE

Parameter HR P

OAS 097 0775

DFS 091 0230



Parameter HR P

DFS 059 0005








bull Impact of pCR




55 Weeks 6 wksTME




Neodjuvant Chemoth

CRT TME



FOLFOX X 8 Courses

CRT + Cape TME

Pathologic Grade


38 7 31


1 14 4 10

2 8 1 7

3 3 1 2



Slide 12







[TITLE]

[TITLE]

The Art for Today






Thank You






Adverse Events













Complete Response

cCRpCR





bull ypT0N0







3 Good gt50





0 - 1 3960005

6300082 - 3 293 736

4 105 895








21 PatientspCR


Wait amp See













Slide 10


Slide 11


Slide 13


Slide 14


Slide 15


Slide 16


Cause of death


Cause of death


Take home messages











Rectal Cancer










NEG

ATI

VE

Parameter HR P

OAS 097 0775

DFS 091 0230



Parameter HR P

DFS 059 0005








bull Impact of pCR




55 Weeks 6 wksTME




Neodjuvant Chemoth

CRT TME



FOLFOX X 8 Courses

CRT + Cape TME

Pathologic Grade


38 7 31


1 14 4 10

2 8 1 7

3 3 1 2



Slide 12







[TITLE]

[TITLE]

The Art for Today






Thank You




Adverse Events













Complete Response

cCRpCR





bull ypT0N0







3 Good gt50





0 - 1 3960005

6300082 - 3 293 736

4 105 895








21 PatientspCR


Wait amp See













Slide 10


Slide 11


Slide 13


Slide 14


Slide 15


Slide 16


Cause of death


Cause of death


Take home messages











Rectal Cancer










NEG

ATI

VE

Parameter HR P

OAS 097 0775

DFS 091 0230



Parameter HR P

DFS 059 0005








bull Impact of pCR




55 Weeks 6 wksTME




Neodjuvant Chemoth

CRT TME



FOLFOX X 8 Courses

CRT + Cape TME

Pathologic Grade


38 7 31


1 14 4 10

2 8 1 7

3 3 1 2



Slide 12







[TITLE]

[TITLE]

The Art for Today






Thank You













Complete Response

cCRpCR





bull ypT0N0







3 Good gt50





0 - 1 3960005

6300082 - 3 293 736

4 105 895








21 PatientspCR


Wait amp See













Slide 10


Slide 11


Slide 13


Slide 14


Slide 15


Slide 16


Cause of death


Cause of death


Take home messages











Rectal Cancer










NEG

ATI

VE

Parameter HR P

OAS 097 0775

DFS 091 0230



Parameter HR P

DFS 059 0005








bull Impact of pCR




55 Weeks 6 wksTME




Neodjuvant Chemoth

CRT TME



FOLFOX X 8 Courses

CRT + Cape TME

Pathologic Grade


38 7 31


1 14 4 10

2 8 1 7

3 3 1 2



Slide 12







[TITLE]

[TITLE]

The Art for Today






Thank You


Complete Response

cCRpCR





bull ypT0N0







3 Good gt50





0 - 1 3960005

6300082 - 3 293 736

4 105 895








21 PatientspCR


Wait amp See













Slide 10


Slide 11


Slide 13


Slide 14


Slide 15


Slide 16


Cause of death


Cause of death


Take home messages











Rectal Cancer










NEG

ATI

VE

Parameter HR P

OAS 097 0775

DFS 091 0230



Parameter HR P

DFS 059 0005








bull Impact of pCR




55 Weeks 6 wksTME




Neodjuvant Chemoth

CRT TME



FOLFOX X 8 Courses

CRT + Cape TME

Pathologic Grade


38 7 31


1 14 4 10

2 8 1 7

3 3 1 2



Slide 12







[TITLE]

[TITLE]

The Art for Today






Thank You






3 Good gt50





0 - 1 3960005

6300082 - 3 293 736

4 105 895








21 PatientspCR


Wait amp See













Slide 10


Slide 11


Slide 13


Slide 14


Slide 15


Slide 16


Cause of death


Cause of death


Take home messages











Rectal Cancer










NEG

ATI

VE

Parameter HR P

OAS 097 0775

DFS 091 0230



Parameter HR P

DFS 059 0005








bull Impact of pCR




55 Weeks 6 wksTME




Neodjuvant Chemoth

CRT TME



FOLFOX X 8 Courses

CRT + Cape TME

Pathologic Grade


38 7 31


1 14 4 10

2 8 1 7

3 3 1 2



Slide 12







[TITLE]

[TITLE]

The Art for Today






Thank You





3 Good gt50





0 - 1 3960005

6300082 - 3 293 736

4 105 895








21 PatientspCR


Wait amp See













Slide 10


Slide 11


Slide 13


Slide 14


Slide 15


Slide 16


Cause of death


Cause of death


Take home messages











Rectal Cancer










NEG

ATI

VE

Parameter HR P

OAS 097 0775

DFS 091 0230



Parameter HR P

DFS 059 0005








bull Impact of pCR




55 Weeks 6 wksTME




Neodjuvant Chemoth

CRT TME



FOLFOX X 8 Courses

CRT + Cape TME

Pathologic Grade


38 7 31


1 14 4 10

2 8 1 7

3 3 1 2



Slide 12







[TITLE]

[TITLE]

The Art for Today






Thank You







21 PatientspCR


Wait amp See













Slide 10


Slide 11


Slide 13


Slide 14


Slide 15


Slide 16


Cause of death


Cause of death


Take home messages











Rectal Cancer










NEG

ATI

VE

Parameter HR P

OAS 097 0775

DFS 091 0230



Parameter HR P

DFS 059 0005








bull Impact of pCR




55 Weeks 6 wksTME




Neodjuvant Chemoth

CRT TME



FOLFOX X 8 Courses

CRT + Cape TME

Pathologic Grade


38 7 31


1 14 4 10

2 8 1 7

3 3 1 2



Slide 12







[TITLE]

[TITLE]

The Art for Today






Thank You




21 PatientspCR


Wait amp See













Slide 10


Slide 11


Slide 13


Slide 14


Slide 15


Slide 16


Cause of death


Cause of death


Take home messages











Rectal Cancer










NEG

ATI

VE

Parameter HR P

OAS 097 0775

DFS 091 0230



Parameter HR P

DFS 059 0005








bull Impact of pCR




55 Weeks 6 wksTME




Neodjuvant Chemoth

CRT TME



FOLFOX X 8 Courses

CRT + Cape TME

Pathologic Grade


38 7 31


1 14 4 10

2 8 1 7

3 3 1 2



Slide 12







[TITLE]

[TITLE]

The Art for Today






Thank You



21 PatientspCR


Wait amp See













Slide 10


Slide 11


Slide 13


Slide 14


Slide 15


Slide 16


Cause of death


Cause of death


Take home messages











Rectal Cancer










NEG

ATI

VE

Parameter HR P

OAS 097 0775

DFS 091 0230



Parameter HR P

DFS 059 0005








bull Impact of pCR




55 Weeks 6 wksTME




Neodjuvant Chemoth

CRT TME



FOLFOX X 8 Courses

CRT + Cape TME

Pathologic Grade


38 7 31


1 14 4 10

2 8 1 7

3 3 1 2



Slide 12







[TITLE]

[TITLE]

The Art for Today






Thank You







Slide 10


Slide 11


Slide 13


Slide 14


Slide 15


Slide 16


Cause of death


Cause of death


Take home messages











Rectal Cancer










NEG

ATI

VE

Parameter HR P

OAS 097 0775

DFS 091 0230



Parameter HR P

DFS 059 0005








bull Impact of pCR




55 Weeks 6 wksTME




Neodjuvant Chemoth

CRT TME



FOLFOX X 8 Courses

CRT + Cape TME

Pathologic Grade


38 7 31


1 14 4 10

2 8 1 7

3 3 1 2



Slide 12







[TITLE]

[TITLE]

The Art for Today






Thank You





Slide 10


Slide 11


Slide 13


Slide 14


Slide 15


Slide 16


Cause of death


Cause of death


Take home messages











Rectal Cancer










NEG

ATI

VE

Parameter HR P

OAS 097 0775

DFS 091 0230



Parameter HR P

DFS 059 0005








bull Impact of pCR




55 Weeks 6 wksTME




Neodjuvant Chemoth

CRT TME



FOLFOX X 8 Courses

CRT + Cape TME

Pathologic Grade


38 7 31


1 14 4 10

2 8 1 7

3 3 1 2



Slide 12







[TITLE]

[TITLE]

The Art for Today






Thank You



Slide 10


Slide 11


Slide 13


Slide 14


Slide 15


Slide 16


Cause of death


Cause of death


Take home messages











Rectal Cancer










NEG

ATI

VE

Parameter HR P

OAS 097 0775

DFS 091 0230



Parameter HR P

DFS 059 0005








bull Impact of pCR




55 Weeks 6 wksTME




Neodjuvant Chemoth

CRT TME



FOLFOX X 8 Courses

CRT + Cape TME

Pathologic Grade


38 7 31


1 14 4 10

2 8 1 7

3 3 1 2



Slide 12







[TITLE]

[TITLE]

The Art for Today






Thank You

Slide 10


Slide 11


Slide 13


Slide 14


Slide 15


Slide 16


Cause of death


Cause of death


Take home messages











Rectal Cancer










NEG

ATI

VE

Parameter HR P

OAS 097 0775

DFS 091 0230



Parameter HR P

DFS 059 0005








bull Impact of pCR




55 Weeks 6 wksTME




Neodjuvant Chemoth

CRT TME



FOLFOX X 8 Courses

CRT + Cape TME

Pathologic Grade


38 7 31


1 14 4 10

2 8 1 7

3 3 1 2



Slide 12







[TITLE]

[TITLE]

The Art for Today






Thank You

Slide 11


Slide 13


Slide 14


Slide 15


Slide 16


Cause of death


Cause of death


Take home messages











Rectal Cancer










NEG

ATI

VE

Parameter HR P

OAS 097 0775

DFS 091 0230



Parameter HR P

DFS 059 0005








bull Impact of pCR




55 Weeks 6 wksTME




Neodjuvant Chemoth

CRT TME



FOLFOX X 8 Courses

CRT + Cape TME

Pathologic Grade


38 7 31


1 14 4 10

2 8 1 7

3 3 1 2



Slide 12







[TITLE]

[TITLE]

The Art for Today






Thank You

Slide 13


Slide 14


Slide 15


Slide 16


Cause of death


Cause of death


Take home messages











Rectal Cancer










NEG

ATI

VE

Parameter HR P

OAS 097 0775

DFS 091 0230



Parameter HR P

DFS 059 0005








bull Impact of pCR




55 Weeks 6 wksTME




Neodjuvant Chemoth

CRT TME



FOLFOX X 8 Courses

CRT + Cape TME

Pathologic Grade


38 7 31


1 14 4 10

2 8 1 7

3 3 1 2



Slide 12







[TITLE]

[TITLE]

The Art for Today






Thank You

Slide 14


Slide 15


Slide 16


Cause of death


Cause of death


Take home messages











Rectal Cancer










NEG

ATI

VE

Parameter HR P

OAS 097 0775

DFS 091 0230



Parameter HR P

DFS 059 0005








bull Impact of pCR




55 Weeks 6 wksTME




Neodjuvant Chemoth

CRT TME



FOLFOX X 8 Courses

CRT + Cape TME

Pathologic Grade


38 7 31


1 14 4 10

2 8 1 7

3 3 1 2



Slide 12







[TITLE]

[TITLE]

The Art for Today






Thank You

Slide 15


Slide 16


Cause of death


Cause of death


Take home messages











Rectal Cancer










NEG

ATI

VE

Parameter HR P

OAS 097 0775

DFS 091 0230



Parameter HR P

DFS 059 0005








bull Impact of pCR




55 Weeks 6 wksTME




Neodjuvant Chemoth

CRT TME



FOLFOX X 8 Courses

CRT + Cape TME

Pathologic Grade


38 7 31


1 14 4 10

2 8 1 7

3 3 1 2



Slide 12







[TITLE]

[TITLE]

The Art for Today






Thank You

Slide 16


Cause of death


Cause of death


Take home messages











Rectal Cancer










NEG

ATI

VE

Parameter HR P

OAS 097 0775

DFS 091 0230



Parameter HR P

DFS 059 0005








bull Impact of pCR




55 Weeks 6 wksTME




Neodjuvant Chemoth

CRT TME



FOLFOX X 8 Courses

CRT + Cape TME

Pathologic Grade


38 7 31


1 14 4 10

2 8 1 7

3 3 1 2



Slide 12







[TITLE]

[TITLE]

The Art for Today






Thank You

Cause of death


Cause of death


Take home messages











Rectal Cancer










NEG

ATI

VE

Parameter HR P

OAS 097 0775

DFS 091 0230



Parameter HR P

DFS 059 0005








bull Impact of pCR




55 Weeks 6 wksTME




Neodjuvant Chemoth

CRT TME



FOLFOX X 8 Courses

CRT + Cape TME

Pathologic Grade


38 7 31


1 14 4 10

2 8 1 7

3 3 1 2



Slide 12







[TITLE]

[TITLE]

The Art for Today






Thank You

Cause of death


Take home messages











Rectal Cancer










NEG

ATI

VE

Parameter HR P

OAS 097 0775

DFS 091 0230



Parameter HR P

DFS 059 0005








bull Impact of pCR




55 Weeks 6 wksTME




Neodjuvant Chemoth

CRT TME



FOLFOX X 8 Courses

CRT + Cape TME

Pathologic Grade


38 7 31


1 14 4 10

2 8 1 7

3 3 1 2



Slide 12







[TITLE]

[TITLE]

The Art for Today






Thank You

Take home messages











Rectal Cancer










NEG

ATI

VE

Parameter HR P

OAS 097 0775

DFS 091 0230



Parameter HR P

DFS 059 0005








bull Impact of pCR




55 Weeks 6 wksTME




Neodjuvant Chemoth

CRT TME



FOLFOX X 8 Courses

CRT + Cape TME

Pathologic Grade


38 7 31


1 14 4 10

2 8 1 7

3 3 1 2



Slide 12







[TITLE]

[TITLE]

The Art for Today






Thank You










Rectal Cancer










NEG

ATI

VE

Parameter HR P

OAS 097 0775

DFS 091 0230



Parameter HR P

DFS 059 0005








bull Impact of pCR




55 Weeks 6 wksTME




Neodjuvant Chemoth

CRT TME



FOLFOX X 8 Courses

CRT + Cape TME

Pathologic Grade


38 7 31


1 14 4 10

2 8 1 7

3 3 1 2



Slide 12







[TITLE]

[TITLE]

The Art for Today






Thank You









Rectal Cancer










NEG

ATI

VE

Parameter HR P

OAS 097 0775

DFS 091 0230



Parameter HR P

DFS 059 0005








bull Impact of pCR




55 Weeks 6 wksTME




Neodjuvant Chemoth

CRT TME



FOLFOX X 8 Courses

CRT + Cape TME

Pathologic Grade


38 7 31


1 14 4 10

2 8 1 7

3 3 1 2



Slide 12







[TITLE]

[TITLE]

The Art for Today






Thank You







Rectal Cancer










NEG

ATI

VE

Parameter HR P

OAS 097 0775

DFS 091 0230



Parameter HR P

DFS 059 0005








bull Impact of pCR




55 Weeks 6 wksTME




Neodjuvant Chemoth

CRT TME



FOLFOX X 8 Courses

CRT + Cape TME

Pathologic Grade


38 7 31


1 14 4 10

2 8 1 7

3 3 1 2



Slide 12







[TITLE]

[TITLE]

The Art for Today






Thank You





Rectal Cancer










NEG

ATI

VE

Parameter HR P

OAS 097 0775

DFS 091 0230



Parameter HR P

DFS 059 0005








bull Impact of pCR




55 Weeks 6 wksTME




Neodjuvant Chemoth

CRT TME



FOLFOX X 8 Courses

CRT + Cape TME

Pathologic Grade


38 7 31


1 14 4 10

2 8 1 7

3 3 1 2



Slide 12







[TITLE]

[TITLE]

The Art for Today






Thank You




Rectal Cancer










NEG

ATI

VE

Parameter HR P

OAS 097 0775

DFS 091 0230



Parameter HR P

DFS 059 0005








bull Impact of pCR




55 Weeks 6 wksTME




Neodjuvant Chemoth

CRT TME



FOLFOX X 8 Courses

CRT + Cape TME

Pathologic Grade


38 7 31


1 14 4 10

2 8 1 7

3 3 1 2



Slide 12







[TITLE]

[TITLE]

The Art for Today






Thank You



Rectal Cancer










NEG

ATI

VE

Parameter HR P

OAS 097 0775

DFS 091 0230



Parameter HR P

DFS 059 0005








bull Impact of pCR




55 Weeks 6 wksTME




Neodjuvant Chemoth

CRT TME



FOLFOX X 8 Courses

CRT + Cape TME

Pathologic Grade


38 7 31


1 14 4 10

2 8 1 7

3 3 1 2



Slide 12







[TITLE]

[TITLE]

The Art for Today






Thank You










NEG

ATI

VE

Parameter HR P

OAS 097 0775

DFS 091 0230



Parameter HR P

DFS 059 0005








bull Impact of pCR




55 Weeks 6 wksTME




Neodjuvant Chemoth

CRT TME



FOLFOX X 8 Courses

CRT + Cape TME

Pathologic Grade


38 7 31


1 14 4 10

2 8 1 7

3 3 1 2



Slide 12







[TITLE]

[TITLE]

The Art for Today






Thank You

Parameter HR P

OAS 097 0775

DFS 091 0230



Parameter HR P

DFS 059 0005








bull Impact of pCR




55 Weeks 6 wksTME




Neodjuvant Chemoth

CRT TME



FOLFOX X 8 Courses

CRT + Cape TME

Pathologic Grade


38 7 31


1 14 4 10

2 8 1 7

3 3 1 2



Slide 12







[TITLE]

[TITLE]

The Art for Today






Thank You





bull Impact of pCR




55 Weeks 6 wksTME




Neodjuvant Chemoth

CRT TME



FOLFOX X 8 Courses

CRT + Cape TME

Pathologic Grade


38 7 31


1 14 4 10

2 8 1 7

3 3 1 2



Slide 12







[TITLE]

[TITLE]

The Art for Today






Thank You


55 Weeks 6 wksTME




Neodjuvant Chemoth

CRT TME



FOLFOX X 8 Courses

CRT + Cape TME

Pathologic Grade


38 7 31


1 14 4 10

2 8 1 7

3 3 1 2



Slide 12







[TITLE]

[TITLE]

The Art for Today






Thank You


FOLFOX X 8 Courses

CRT + Cape TME

Pathologic Grade


38 7 31


1 14 4 10

2 8 1 7

3 3 1 2



Slide 12







[TITLE]

[TITLE]

The Art for Today






Thank You

Slide 12







[TITLE]

[TITLE]

The Art for Today






Thank You







[TITLE]

[TITLE]

The Art for Today






Thank You






[TITLE]

[TITLE]

The Art for Today






Thank You





[TITLE]

[TITLE]

The Art for Today






Thank You



[TITLE]

[TITLE]

The Art for Today






Thank You

[TITLE]

[TITLE]

The Art for Today






Thank You

[TITLE]

The Art for Today






Thank You

The Art for Today






Thank You

Thank You

Date post:	22-Jan-2018
Category:	Health & Medicine
Upload:	mohamed-abdulla
View:	296 times
Download:	1 times

Neoadjuvant therapy of rectal cancer

Health & Medicine