{"entity":{"id":"paper-rapido-lancet-oncol-2021","kind":"paper","name":"RAPIDO: short-course radiotherapy followed by chemotherapy before surgery for high-risk locally advanced rectal cancer","aka":[],"tldr":"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.\n\nDisease-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.","asOf":"2026-09-17","links":[{"label":"Lancet Oncol 2021","url":"https://doi.org/10.1016/S1470-2045(20)30555-6"},{"label":"PubMed","url":"https://pubmed.ncbi.nlm.nih.gov/33301740/"}],"tags":[],"related":[],"cancers":["rectal-cancer"],"sections":[],"technologies":[],"targets":[],"drugs":[],"companies":[],"institutions":[],"pathways":[],"terms":[],"trials":["rapido"],"people":[],"bottlenecks":[],"keyPapers":[],"journals":["lancet-oncology"],"dependsOn":[],"notes":[],"journal":"The Lancet Oncology","year":2021,"doi":"10.1016/S1470-2045(20)30555-6","pmid":"33301740","authors":"Bahadoer RR, Dijkstra EA, van Etten B, et al.","paperType":"rct","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."],"whatItMeans":"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."],"changedPractice":true,"participants":912},"route":"/key-papers/paper-rapido-lancet-oncol-2021/","neighbours":{"cancer":[{"id":"rectal-cancer","kind":"cancer","name":"Rectal cancer","route":"/cancers/rectal-cancer/"}],"trial":[{"id":"rapido","kind":"trial","name":"RAPIDO","route":"/trials/rapido/"}],"journal":[{"id":"lancet-oncology","kind":"journal","name":"The Lancet Oncology","route":"/journals/lancet-oncology/"}]}}