Response-adapted Total Neoadjuvant Therapy Guided by Induction Chemotherapy in Early- and Intermediate-risk Low Rectal Cancer for Implementation of a Watch-and-wait Strategy

This study is testing a treatment approach for low rectal cancer (cancer in the last part of the bowel, close to the anal opening) where patients receive chemotherapy first, and those whose tumor shrinks significantly may be able to avoid surgery altogether — a strategy called 'watch and wait.' **You may be eligible if...** - You are between 18 and 80 years old - You have confirmed rectal adenocarcinoma (a specific type of rectal cancer) - The bottom of the tumor is within 5 cm of the anal opening - Your cancer is at an early or intermediate stage (no distant spread) - Your cancer is classified as pMMR/MSS (a specific tumor type that responds to this approach) **You may NOT be eligible if...** - Your cancer has spread to distant organs (stage IV) - Your tumor has specific high-risk genetic features that require different treatment - You have had prior pelvic radiation or other treatments affecting eligibility Talk to your doctor to see if this trial is right for you.