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

Inclusion Criteria:

1. Adenocarcinoma of the rectum cT3 or cT4 or cN+, M0 and for which CPR recommendspreoperative radiochemotherapy

2. Tumor <15 cm of the anal margin in rigid or subperitoneal rectoscopy at the MRI

3. Tumor potentially resectable from the outset, or considered to be resectable afterradiochemotherapy

4. Operable Patient

5. Age between 18 and 75

6. OMS performance status 0-2

7. No co-morbidity likely to prevent the delivery of treatment

8. Adequate contraception for men, and for non-menopausal women

9. Neurotrophic neutrophils 1500 / mm3, platelets 100 000 / mm3, and hemoglobin 10 g / dL

10. Bilirubin ≤ 1.5 times the upper limit of normal (LNS), ASAT and ALAT ≤ 1.5LNS,Alkaline phosphatase ≤ 1.5 LNS

11. Creatinine clearance> 50 mL / min

12. Patient must have been informed and must have signed the specific informed consentform.

13. Patient must be affiliated to a Social Health Insurance.

Exclusion Criteria:

1. Remote metastasis

2. Cancer not resectable

3. Contraindication to capecitabine and its excipients

4. Previous history of pelvic radiotherapy or previous chemotherapy

5. History of inflammatory bowel or rectum disease

6. History of angina pectoris monitored or myocardial infarction or heart failure

7. Active active infection or other serious underlying condition that may prevent thepatient from receiving treatment

8. Other concomitant cancer, or history of cancer other than in situ cancer of thetreated cervix or basal cell carcinoma or squamous cell carcinoma

9. Patient already included in another therapeutic trial with an experimental molecule

10. Pregnant woman, likely to be pregnant or nursing

11. Persons deprived of their liberty or under guardianship

12. Patient unable to comply with the required medical follow-up for geographic, social orpsychological reasons