Total Neoadjuvant Therapy in Rectal Cancer

This study tests a "total neoadjuvant therapy" (TNT) approach — delivering all or most cancer treatment (chemotherapy and radiation) before surgery — for rectal cancer patients. The goal is to improve tumor shrinkage and potentially allow organ-preserving approaches in patients who respond completely. **You may be eligible if...** - You are 18–75 with locally advanced rectal cancer (cancer that has grown into surrounding tissue or lymph nodes) - You have not had prior treatment for this cancer - Your general health allows chemotherapy and radiation **You may NOT be eligible if...** - Your cancer has spread to distant organs (Stage IV) - You have had prior pelvic radiation - You have serious heart, liver, kidney, or blood disorders - You are pregnant - You have an active second cancer Talk to your doctor to see if this trial is right for you.