# RAPIDO: short-course radiotherapy followed by chemotherapy before surgery for high-risk locally advanced rectal cancer

Source: https://onco.cc/key-papers/paper-rapido-lancet-oncol-2021/  
OnCo record `paper-rapido-lancet-oncol-2021` (Key paper). Data CC BY-NC 4.0, attribute "Data from OnCo (onco.cc)"; commercial use needs a licence.

## TL;DR

Giving all treatment before surgery, with a week of radiotherapy followed by four to five months of chemotherapy, halved distant metastases and doubled the complete response rate compared with standard chemoradiation in high-risk rectal cancer.

## Summary

Phase 3 trial of 912 patients with high-risk locally advanced rectal adenocarcinoma randomised to short-course radiotherapy (5 x 5 Gy) followed by six cycles of CAPOX or nine of FOLFOX then total mesorectal excision, or standard long-course chemoradiotherapy, surgery and optional adjuvant chemotherapy.

Disease-related treatment failure at three years was 23.7 versus 30.4 percent, distant metastases 20.0 versus 26.8 percent and pathological complete response 28 versus 14 percent; longer follow-up showed more locoregional failures in the experimental arm.

## Fields

- Kind: Key paper
- Last checked: 2026-09-17
- Journal: The Lancet Oncology
- Year: 2021
- DOI: 10.1016/S1470-2045(20)30555-6
- Authors: Bahadoer RR, Dijkstra EA, van Etten B, et al.
- Findings: Three-year disease-related treatment failure 23.7 percent vs 30.4 percent; hazard ratio 0.75.; Pathological complete response 28 percent vs 14 percent.
- What it means: Total neoadjuvant therapy is now a standard for high-risk rectal cancer, improving compliance with chemotherapy and enabling organ preservation, though the locoregional recurrence signal favours long-course chemoradiation in some patients.
- Caveats: Five-year locoregional failure was higher with the experimental arm (10 vs 6 percent).; No overall survival difference.

## Sources

- Lancet Oncol 2021: https://doi.org/10.1016/S1470-2045(20)30555-6
- PubMed: https://pubmed.ncbi.nlm.nih.gov/33301740/

## Connected records

- cancers: [Rectal cancer](https://onco.cc/cancers/rectal-cancer/)
- trials: [RAPIDO](https://onco.cc/trials/rapido/)
- journals: [The Lancet Oncology](https://onco.cc/journals/lancet-oncology/)

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