Consolidation Versus Induction Chemotherapy in Total Neoadjuvant Therapy of Rectal Cancer With High Risk for Recurrence

This study compares two approaches to delivering chemotherapy as part of a full pre-surgery treatment plan (total neoadjuvant therapy) for high-risk rectal cancer: giving chemotherapy before radiation (induction) versus after radiation (consolidation). The goal is to find out which sequence better shrinks the tumor and reduces the risk of cancer coming back. **You may be eligible if...** - You have confirmed rectal cancer (adenocarcinoma) with no spread to distant organs - Your MRI shows at least one high-risk feature: large tumor (T4), many lymph nodes involved (N2), tumor growing into blood vessels, positive lateral lymph nodes, or tumor very close to the mesorectal boundary - You are willing to attend regular check-ups **You may NOT be eligible if...** - You have received prior pelvic radiation - You have cancer spread to other organs - You have inflammatory bowel disease - MRI is contraindicated for you - You have a second cancer at the same time Talk to your doctor to see if this trial is right for you.