Intensity Modulated Radiation Therapy (IMRT) for Patients With Rectal Cancer

Phase 2

Terminated

Brief Summary: This study will investigate short course radiation therapy using IMRT as an alternative to standard chemo radiation because prior studies have shown that this method of treatment will potentially reduce some fo the side effects of standard treatment, improve quality of life, and help to control the growth of rectal cancer cells. IMRT is a type of radiation that uses computer-generated images to match radiation to the size and shape of the tumor. Since the intensity of each radiation beam can be controlled, the radiation dose can wrap around normal tissue which allows the study doctor to deliver a higher dose of radiation to the tumor with less damage to nearby healthy tissue. The purpose of this research study is to see what impact this treatment will have on quality of life, as well as to see if there are any late side effects that come about after the participant has completed the treatment.

Detailed Description: * Radiation treatment to the rectum will be given once a day, for 5 days. Each radiation treatment will take about 20-30 minutes.

* The following procedures will be performed on day 1 of radiation treatment: physical examination, blood tests and quality of life questionnaire.

* During radiation treatment a physical examination will be performed once during the 5 days of radiation treatment. A Quality of Life Questionnaire will be administered on the last day of radiation treatment.

* Surgery will be performed within 3-14 days after the last day of radiation treatment.

Recruitment & Eligibility

Inclusion Criteria

Histologically or cytologically confirmed adenocarcinoma of the rectum
T3 or N+ disease by MRI or endoscopic ultrasound. Metastatic disease is permitted, except for known brain metastases, as long as local treatment with RT and surgery is recommended.
Prior chemotherapy is permitted. For patients who have previously received bevacizumab, the last dose must be greater than 4 weeks prior to initiation of radiation therapy.
18 years of age or older
Life expectancy of greater than 3 months
ECOG (Eastern Cooperative Oncology Group) Performance Status of 0, 1 or 2
Normal organ and marrow function as outlined in the protocol
Women of child-bearing potential and men must agree to use of adequate contraception prior to study entry and for the duration of study participation

Exclusion Criteria

Pelvic radiotherapy prior to entering the study or those who have not recovered from adverse events due to agents administered more than 4 weeks earlier
Participants may not be receiving any other investigational agents. Patients may not be receiving any other treatment for their rectal cancer during study participation
Participants with known brain metastases are excluded from this clinical trial because of their poor prognosis and because they often develop progressive neurologic dysfunction that would confound the evaluation of neurologic and other adverse events
History of known radiation sensitivity syndrome
History of inflammatory bowel disease
Active scleroderma or CREST syndrome
Uncontrolled intercurrent illness including, but not limited to, ongoing or active infection, symptomatic congestive heart failure, unstable angina pectoris, cardiac arrhythmia, or psychiatric illness/social situations that would limit compliance with study requirements
Pregnant or nursing women

Arm && Interventions

Group	Intervention	Description
Short course IMRT	Intensity Modulated Radiation Therapy	Patients will receive short course IMRT (Intensity Modulated Radiation Therapy) prior to surgery. Dose will be 5 Gy x 5, followed by surgery the week after

Primary Outcome Measures

Name	Time	Method
Bowel Quality of Life	2 years	To determine the rate of fecal incontinence at 1 year in patients undergoing an low anterior resection (LAR), as measured by bowel quality of life measure after preoperative conformal radiation therapy delivered in one week for rectal cancer.

Secondary Outcome Measures

Name	Time	Method
Pelvic Control Rate	2 years	To determine the pelvic control rate of patients after short course radiation therapy and surgery.
Quantity of Circulating Tumor Cells	2 years	To determine the impact of radiation and surgery on quantity of circulating tumor cells in both metastatic and non-metastatic patients.
Surgical Complication Rate	2 years	To determine the surgical complication rate in patients who received preoperative radiation therapy.
Tissue Microarray	2 years	To determine changes in the tumor induced by radiation as assessed by tissue microarray.
Accuracy	2 years	To determine the accuracy of advanced MRI imaging and PET (Positron Electron Tomography) /CT in predicting nodal stage.