Neo-Adjuvant FOLFOX for Rectal Carcinoma

Inclusion Criteria

1. Patients must consent to participate in the study and must have signed and dated an IRB-approved consent form conforming to federal and institutional guidelines
2. Patient must have histologically proven adenocarcinoma of the rectum with no distant metastases
3. Tumor stage must be T3N0M0, T1-3 N1M0 assessed by clinical exam, TRUS, MRI and CT. Pre-operative evidence of T4, N2 or distal lesions (0-6 cm from anal verge) should receive preoperative RT and not be offered this protocol. Any pT4, pN2 or CRM+ patients should be offered postoperative radiation
4. The proximal border of the tumor must be at or below 12 centimeters of the anal verge by proctoscopic examination
5. The distal border of the tumor must be at or above 6 cm from the anal verge on preoperative proctoscopy with the patient in the left lateral decubitus position
6. Patient must have had no prior chemotherapy or pelvic irradiation
7. Karnofsky performance status of 60 or greater; ECOG performance status 0-1
8. Patients should be age 18 years and older
9. Pretreatment absolute neutrophil count \>= 1000/mm3 and platelets \>= 100,000/mm3
10. Serum creatinine \<= 1.5 x ULN; bilirubin \<= 1.5 x ULN; ALT\<= 2.5 x ULN

Exclusion Criteria

1. Patients can not be receiving any other investigational agents
2. Patients with known metastases will be excluded from the study
3. Patients with history of significant neuropathy or current symptoms of neuropathy
4. Patients with history of allergic reactions attributed to compounds of similar chemical or biologic composition to oxaliplatin or 5-FU or leucovorin
5. Patients with uncontrolled intercurrent illness 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
6. Pregnant women are excluded from this study because oxaliplatin and 5-FU/LV are agents with the potential for teratogenic or abortifacient effects. Because there is an unknown but potential risk for adverse events in nursing infants secondary to treatment of the mother with oxaliplatin and 5-FU/LV, breastfeeding should be discontinued if the mother is treated with these agents
7. HIV positive patients
8. Patients with serious comorbid disease which prevents delivery of full treatment including psychiatric disorders and cardiopulmonary disease
9. No history within the past 5 years of a cancer diagnosis except for non-melanomatous skin cancers or in situ cervix carcinoma
10. Patients with clinically significant peripheral neuropathy at the time of start of treatment (defined in the NCI Common Terminology Criteria for Adverse Events Version 3\[CTCAE v3.0\] as grade 2 or greater neurosensory or neuromotor toxicity