Hyperthermia With Chemoradiotherapy in Rectal Cancer

Inclusion Criteria: * Male and female patients with histologically confirmed diagnosis of rectal cancer localized 0-12 cm from the anocutaneous line (i.e. lower and middle third of the rectum) * Indication for total neoadjuvant therapy irrespective of participation in the current study. * Any MRI staged rectal cancer with one of the following high-risk features: * cT4 * cN2 (see Appendix) * Distance to mesorectal fascia 1mm or less. * Involved Lateral pelvic lymph nodes * EMVI (extramural venous invasion) positivity * Staging requirements: High-resolution, thin-sliced (i.e. 3mm) magnetic resonance imaging (MRI) of the pelvis is the mandatory local staging procedure. * Cross-sectional imaging of the abdomen and chest to exclude distant metastases. * Aged at least 18 years. No upper age limit. * WHO/ECOG Performance Status ≤ 1 * Adequate hematological, hepatic, renal and metabolic function parameters * Informed consent of the patient Exclusion Criteria: * Lower border of the tumor localised more than 12 cm from the anocutaneous line as measured by rigid rectoscopy * Tumors with microsatellite instability ("MSI-High Tumors") and the possibility for treatment with immune checkpoint inhibition. * Contraindication for hyperthermia such as metal implants or pacemakers * Distant metastases (to be excluded by CT scan of the thorax and abdomen) * Preexisting fecal incontinence for solid stool * Prior antineoplastic therapy for rectal cancer * Prior radiotherapy of the pel…