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Moving all the chemotherapy in front of the operation, after one week of radiotherapy, cut three-year treatment failure from 30.4 to 23.7 percent in high-risk rectal cancer.
RAPIDO recruited from 54 centres in the Netherlands, Sweden, Spain, Slovenia, Denmark, Norway and the United States. Patients aged 18 or older with biopsy-proven, newly diagnosed, primary locally advanced rectal adenocarcinoma classified as high risk on pelvic MRI (cT4a or cT4b, extramural vascular invasion, cN2, involved mesorectal fascia, or enlarged lateral lymph nodes) were randomised 1:1. The experimental group received short-course radiotherapy (5 x 5 Gy over a maximum of eight days) followed by six cycles of CAPOX or nine of FOLFOX4 and then total mesorectal excision; the standard of care group received 28 daily fractions of 1.8 Gy to 50.4 Gy or 25 of 2.0 Gy to 50.0 Gy with concomitant capecitabine, then total mesorectal excision and, where hospital policy stipulated, adjuvant chemotherapy.
The primary endpoint was three-year disease-related treatment failure, defined as the first occurrence of locoregional failure, distant metastasis, new primary colorectal tumour or treatment-related death.
The first total neoadjuvant therapy trial to change practice in high-risk rectal cancer, and the schedule that makes organ preservation possible by giving the tumour months rather than weeks to respond.
Organ preservation became a plan rather than an accident: consolidation chemotherapy after chemoradiotherapy gives the best chance of keeping the rectum, and salvage surgery after regrowth does not appear to cost survival.
The second total neoadjuvant therapy schedule to change practice, and the one that shows the advantage is partly deliverability: chemotherapy given before an operation is completed by far more patients than chemotherapy given after one.
Shares Cornelis J. H. van de Velde, Total mesorectal excision (TME), Radiotherapy, Surgery and radiotherapy cure most, get least and the tag colorectal-evidence.
Shares Organ preservation in patients with rectal adenocarcinoma treated with total neoadjuvant therapy (OPRA), Randomise organ preservation against surgery in mismatch repair-proficient rectal cancer, with bowel function as a co-primary endpoint, Radiotherapy, Chemoradiation (chemoradiotherapy, CRT) and the tag colorectal-evidence.
Shares Total mesorectal excision (TME), Radiotherapy, Chemoradiation (chemoradiotherapy, CRT), Surgery and radiotherapy cure most, get least and the tag colorectal-evidence.
Shares Total mesorectal excision (TME), Radiotherapy, Surgery and radiotherapy cure most, get least, Colorectal cancer roadmap: from the adenoma-carcinoma sequence and the first screening trials to total mesorectal excision, oxaliplatin, RAS testing, immunotherapy for mismatch repair-deficient disease, ctDNA-guided treatment and organ preservation and the tag colorectal-evidence.
Shares Surgery and radiotherapy cure most, get least, CAPOX (capecitabine, oxaliplatin), Oxaliplatin, Colorectal cancer roadmap: from the adenoma-carcinoma sequence and the first screening trials to total mesorectal excision, oxaliplatin, RAS testing, immunotherapy for mismatch repair-deficient disease, ctDNA-guided treatment and organ preservation and the tag colorectal-evidence.
Shares Total mesorectal excision (TME), Surgery and radiotherapy cure most, get least, Colorectal cancer roadmap: from the adenoma-carcinoma sequence and the first screening trials to total mesorectal excision, oxaliplatin, RAS testing, immunotherapy for mismatch repair-deficient disease, ctDNA-guided treatment and organ preservation, Rectal cancer and the tag colorectal-evidence.
Shares Surgery and radiotherapy cure most, get least, Oxaliplatin, MRI, Colorectal cancer roadmap: from the adenoma-carcinoma sequence and the first screening trials to total mesorectal excision, oxaliplatin, RAS testing, immunotherapy for mismatch repair-deficient disease, ctDNA-guided treatment and organ preservation and the tag colorectal-evidence.
Shares Organ preservation in patients with rectal adenocarcinoma treated with total neoadjuvant therapy (OPRA), Randomise organ preservation against surgery in mismatch repair-proficient rectal cancer, with bowel function as a co-primary endpoint, Surgery and radiotherapy cure most, get least, Colorectal cancer roadmap: from the adenoma-carcinoma sequence and the first screening trials to total mesorectal excision, oxaliplatin, RAS testing, immunotherapy for mismatch repair-deficient disease, ctDNA-guided treatment and organ preservation and the tag colorectal-evidence.