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Session:: ePosters-Sun800-M1: Rectal Cancer

EP209 - Safety and Efficacy of Total Neoadjuvant Therapy Utilizing Short Course Radiotherapy and Consolidation FOLFOX Chemotherapy for Locally Advanced Rectal Adenocarcinoma

Sunday, May 10, 2026
8:54 AM - 8:59 AM ET

    ePoster Presenter(s)

  • Grace R. Thompson, MD

    Resident Physician, General Surgery
    University of Florida, College of Medicine, Department of Surgery
    UF College of Medicine, Department of Surgery
    Gainesville, FL, United States

    Disclosure information not submitted.

    • Author(s)

  • Pavel Mazirka, MD

    Surgery Resident
    University of Florida - Gainesville, FL
    University of Florida
    Gainesville, FL, United States

    Disclosure information not submitted.

  • AC

    Angel Charles, MD

    University of Florida

    Disclosure information not submitted.

  • Christine Rodhouse, MD (she/her/hers)

    Resident physician
    University of Florida
    University of Florida
    Gainesville, FL, United States

    Disclosure information not submitted.

  • GT

    Gerik W. Tushoski-Alemán, MSE

    Clinical Researcher
    University of Florida
    Gainesville, Florida, United States

    Disclosure information not submitted.

  • Jeremy A. Balch, MD, PhD (he/him/his)

    House Officer
    University of Florida
    University of Florida
    Gainesville, Florida, United States

    Disclosure information not submitted.

  • TG

    Thomas J. George, MD, FACP, FASCO

    Professor and Deputy Director
    University of Florida Health Cancer Center
    Gainesville, Florida, United States

    Disclosure information not submitted.

  • GG

    Gahyun Gim, MD

    Assistant Professor
    University of Florida
    Gainesville, Florida, United States

    Disclosure information not submitted.

  • KH

    Kathryn E. Hitchcock, MD PhD

    Associate Professor
    Dept of Radiation Oncology, U. of Florida
    Gainesville, Florida, United States

    Disclosure information not submitted.

  • RZ

    Robert A. Zlotecki, MD, PhD

    Professor
    Medical University of South Carolina, Department of Radiation Oncology
    Murrells Inlet, South Carolina, United States

    Disclosure information not submitted.

  • JG

    Joseph Grajo, MD

    Junior Associate Professor
    University of Florida
    Gainesville, Florida, United States

    Disclosure information not submitted.

  • PM

    Patricia P. Moser, MD

    Associate Professor and Diagnostic Radiologist
    University of Florida, Department of Radiology
    Gainesville, Florida, United States

    Disclosure information not submitted.

  • MF

    Michael Feely, DO

    Associate Professor
    University of Florida
    Gainesville, Florida, United States

    Disclosure information not submitted.

  • JN

    Johan Nordenstam, MD, PhD

    Associate Professor
    University of Florida, College of Medicine, Department of Surgery
    Gainesville, Florida, United States

    Disclosure information not submitted.

  • KT

    Krista P. Terracina, MD

    Assistant Professor
    University of Florida, College of Medicine, Department of Surgery
    Gainesville, Florida, United States

    Disclosure information not submitted.

    • Senior Author(s)

  • Thomas E. Read, MD

    Professor and Chief, Division of Gastrointestinal Surgery
    Dept of Surgery Univ of Hawaii
    University of Hawaii John A. Burns School of Medicine
    Honolulu, Hawaii, United States

    All of the relevant financial relationships listed below have been mitigated.
    This individual has no financial relationships with ineligible companies.

All of the relevant financial relationships listed below have been mitigated.
Thomas E. Read, MD: This individual has no financial relationships with ineligible companies.
Purpose/Background: Total neoadjuvant therapy (TNT) is commonly employed for locally advanced rectal cancer. When consolidation chemotherapy is used, and the interval between radiotherapy and surgery increases, there are concerns that pelvic fibrosis may adversely impact the ability to achieve negative resection margins and lead to postoperative pelvic complications. There are also concerns that these effects are magnified when using neoadjuvant short course radiotherapy (SCRT) prior to consolidation chemotherapy. We report our experience treating patients with SCRT and consolidation chemotherapy with 8 cycles of FOLFOX followed by proctectomy, focusing on short term outcomes.

Methods/Interventions: Retrospective review of 256 consecutive patients with rectal adenocarcinoma treated at an NAPRC-accredited single institution between May 2019-June 2025. The study population consisted of 61 patients (35M/26F, mean age 58) who underwent TNT with SCRT (5Gy x 5 fractions) with consolidation chemotherapy (intended 8 cycles of FOLFOX) then planned proctectomy. Patients receiving at least one cycle of FOLFOX were analyzed on an intention-to-treat basis. Patients were excluded due to: no proctectomy (n= 90); alternative neoadjuvant therapy regimen (n=47); no neoadjuvant therapy (n= 36); surgery elsewhere (n= 8); ongoing treatment (n= 14). Outcomes of interest included circumferential radial margin status, anastomotic leak, and unintended permanent stoma. Positive margin was defined as tumor <= 1mm from resection margin. Anastomotic leak was defined as leakage of air, fluid, enteric contents or contrast through an anastomosis identified on radiologic imaging or on return to the operating room. Unintended permanent stoma was defined as postoperative creation of permanent stoma, or failure to close temporary stoma following restorative operation.

Results/Outcomes: Study patients were predominately male (35/61, 57%), non-smokers (46/61, 75%), median age 59 yrs (IQR 17). 58% of tumors were in the mid/distal rectum. Pretreatment clinical stages were I (n= 0), II (n= 8, 13%), III (n= 46, 75%), IV (n= 7, 12%). Based on pretreatment pelvic magnetic resonance imaging with rectal cancer protocol (MR) the mesorectal fascia was involved in 25/61 (41%). All 61 patients completed SCRT and 46/61 (75%) completed 8 cycles of FOLFOX. 58/61 (95%) patients underwent post-treatment/pre-operative restaging MR, which suggested persistent tumor in 44/58 (76%). Proctectomy was performed at a median of 24 (IQR 8) weeks after completion of radiotherapy. Histologic evaluation revealed persistent tumor in 45/61 (84%). Histologic circumferential radial margin involvement was found in 4 (10%), an absolute reduction of 31% compared to pretreatment MR estimate of mesorectal fascia involvement. 40/61 (66%) patients underwent restorative procedures, including 6 patients without, and 34 with temporary stoma. 6/6 (100%) patients without diversion remained stoma free and 29/34 (85%) with temporary stoma had subsequent stoma closure. Unintended permanent stoma rate was 5/40 (13%), due to anastomotic leak (n=3), progression of tumor (n=1), and colon conduit stricture (n=1). Anastomotic leak at the colorectal/coloanal anastomosis occurred in 3/40 (8%) patients.

Conclusion/Discussion: Total neoadjuvant therapy with short course radiotherapy and consolidation chemotherapy with 8 cycles of FOLFOX followed by proctectomy is safe and efficacious for patients with locally advanced rectal adenocarcinoma, including those with pretreatment mesorectal fascial involvement.