Total Neoadjuvant Treatment Without Surgery For Locally Advanced Rectal Cancer

Inclusion Criteria:

* Histologically confirmed diagnosis of adenocarcinoma of the medium/lower rectum
* Patients must have Stage II (cT3-4 N0) or Stage III (cT1-4, N1-3) tumor
* Locally advanced rectal cancer amenable to Total Mesorectal Excision (TME)/Abdominal-Perineal Amputation
* No evidence of distant metastases by chest, abdomen, and pelvis contrast enhanced CT scan (TC-positron emission computed tomography (PET) Whole Body (WB) is acceptable alternative in patient allergic to iodate contrast medium)
* No prior pelvic radiation therapy
* No prior oncologic medical therapy or surgery for rectal cancer
* Age \>18 years
* No infections requiring systemic antibiotic treatment
* Performance status 0-1 (ECOG Scale)
* absolute neutrophil count (ANC) \> 1.5 cell/mm3, Hb\>8.0 g/ dL, Platelet Count (PLT)\>150,000/mm3, total bilirubin \< or equal or 1.5 x upper limit of normal, Aspartate Aminotransferase (AST) \< or equal to three times upper limit of normal, Alanine Aminotransferase (ALT)\< or equal to three times upper limit of normal; Serum creatinine level \< or equal to 1.5 times the upper limit of normal
* Patients must read, agree to, and sign a statement of Informed Consent prior to participation
* Women with childbearing potential who are negative for pregnancy test (urine or blood) and who agree to use effective contraceptive methods
* Male subjects must also agree to use effective contraception

Exclusion Criteria:

* Recurrent rectal cancer
* Patients with a history of any arterial thrombotic event within the past 6 months, including angina (stable or unstable), MI, or CVA
* Intolerance or contraindication to Magnetic Resonance (MR) procedure
* Patients with any other concurrent medical or psychiatric condition
* Gastro-intestinal abnormalities, inability to take oral medication, any condition affecting absorption
* Patients with a history of a prior malignancy within the past 5 years, except for adequately treated basal cell or squamous cell skin cancer, or in situ cervical cancer.
* Patients with a history of thrombotic episodes, such as deep venous thrombosis, pulmonary embolus, Myocardial Infarction (MI) or cerebral vascular accident (CVA) occurring more than 6 months prior to enrollment may be considered for protocol participation, provided they are on stable doses of anticoagulant therapy. Patients who are anticoagulated for atrial fibrillation or other conditions may participate, provided they are on stable doses of anticoagulant therapy.
* Patients receiving other anticancer or experimental therapy.