RAPIDO
RAPIDO showed that giving one week of radiotherapy and then all the chemotherapy before surgery cuts distant spread and doubles complete responses in high-risk rectal cancer, establishing total neoadjuvant therapy.
Overview
RAPIDO randomised 920 patients with high-risk rectal cancer on MRI to short-course radiotherapy (25 Gy in five fractions) followed by six cycles of CAPOX or nine of FOLFOX then surgery, or to standard capecitabine chemoradiation, surgery and optional adjuvant chemotherapy. Disease-related treatment failure at three years was 23.7 percent with the experimental approach versus 30.4 percent, driven by fewer distant metastases, and pathological complete response doubled to 28 percent (Bahadoer and colleagues, Lancet Oncology 2020). Later follow-up reported more local regrowth in the experimental arm, tempering enthusiasm for the shortest radiotherapy.
- 23.7 vs 30.4 out of 100 reached this endpoint at 3 years with Total neoadjuvant therapy compared with Standard chemoradiation; 6.7 fewer per 100.
- On this measure the first group did worse, not better.
- This endpoint is not one of the standard survival or response measures; read it alongside the trial's primary result.
- These results apply to the people the trial enrolled: High-risk locally advanced rectal cancer: short-course radiotherapy then chemotherapy before surgery (total neoadjuvant therapy) versus standard chemoradiation, surgery and optional adjuvant chemotherapy. People in a different situation may not see the same effect.
Numbers are from the trial as recorded here; see the source links in the table below. This is orientation, not medical advice: ask your team how closely the trial population matches you.
920 participants enrolled.
| Endpoint | Arm | n | Value | HR (95% CI) | p | Source |
|---|---|---|---|---|---|---|
| Disease-related treatment failure at 3 yearsprimary | Total neoadjuvant therapy | 462 | 23.7% | - | - | - |
| Standard chemoradiation | 450 | 30.4% |
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