Can adding chemo after radiation help older adults with rectal cancer avoid surgery?

Copied word for word from the study's registry entry, so the wording is the study team's rather than ours.

Inclusion Criteria: 1. Histologically confirmed diagnosis of adenocarcinoma of the rectum 2. Age ≥75 years 3. WHO performance status 0-1 4. cT3a-b with maximum diameter \> 5 cm, T3c-d or cT4 tumor on pretreatment pelvic MRI 5. General condition considered suitable for radical pelvic surgery and a systemic therapy with FOLFOX, 6. Distal part of the tumor ≤10 cm from the anal margin, the measurement done by pelvic MRI 7. Oncogeriatrician approval 8. Adequate biological function defined by: 1. Neutrophils ≥ 1500/mm3 2. Platelets ≥ 100 000/mm3 3. Hemoglobin ≥ 10g/dL 4. Total bilirubin ≤ 1,5 x ULN 5. Alkaline phosphatases ≤ 1,5 x ULN 6. Creatinine clearance \>50mL/mn (MDRD) 9. Men must agree to use adequate contraception methods for the duration of study treatment and for within 6 months after completing treatment 10. Patients must be affiliated to a Social Security System (or equivalent). 11. Patient must have signed a written informed consent prior to any trial specific procedures. When the patient is physically unable to give their written consent, a trusted person of their choice, independent from the investigator or the sponsor, can confirm in writing the patient's consent 12. Patients must be willing and able to comply with the protocol for the duration of the study including scheduled visits, treatment plan, laboratory tests and other study procedures. Exclusion Criteria: 1. Metastatic disease 2. Other cancer within 3 years prior to rectal cancer diagnosis (except for in situ cancer and basal cell carcinoma of the skin) 3. Non resectable cancer, including extension to prostate or extension to perineal muscles 4. History of pelvic irradiation 5. Contraindication to FOLFOX 4s chemotherapy and/or radiotherapy and/or TME surgery 6. Contraindication to MRI 7. Microsatellite instability (MSI) and/or mismatch repair deficiency (dMMR) 8. Complete or partial Dihydropyrimidine Deshydrogenase (DPD) deficiency (uracilemia ≥ 16 ng/mL) 9. Arterial or venous thrombotic or embolic events such as cerebrovascular accident (including transient ischemic attacks), deep vein thrombosis or pulmonary embolism within 6 months before start of treatment 10. Any other serious concomitant disease or disorder that may interfere with the patient's participation in the study and safety during the study (e.g., severe liver, heart, kidney, lung, metabolic, or psychiatric disorders). 11. Concurrent treatment with other experimental drugs or other anti-cancer therapy, treatment in a clinical trial within 30 days prior to randomization 12. Any psychiatric disorder precluding understanding of information of trial related topics and giving informed consent 13. No prior chemotherapy or surgery for rectal cancer 14. Any serious underlying medical condition (as judged by the investigator) that could impair the ability of the patient to participate in the trial 15. Persons deprived of their liberty or under protective custody or guardianship. 16. Patients unwilling or unable to comply with the medical follow-up required by the trial because of geographic, familial, social, or psychological reasons.