# RAPIDO

Source: https://onco.cc/trials/rapido/  
OnCo record `rapido` (Trial). Data CC BY-NC 4.0, attribute "Data from OnCo (onco.cc)"; commercial use needs a licence.

## TL;DR

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.

## Summary

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.

## Fields

- Kind: Trial
- Status: positive
- Last checked: 2026-09-17
- Tags: radiation-wave4
- Registry id: NCT01558921
- Phase: 3
- Setting: High-risk locally advanced rectal cancer: short-course radiotherapy then chemotherapy before surgery (total neoadjuvant therapy) versus standard chemoradiation, surgery and optional adjuvant chemotherapy
- Sponsor: University Medical Centre Groningen
- Enrolled: 920
- Result: 3-year disease-related treatment failure 23.7% vs 30.4%; pathological complete response 28% vs 14%.
- Outcomes: Disease-related treatment failure at 3 years: Total neoadjuvant therapy 23.7% vs Standard chemoradiation 30.4%

## Sources

- ClinicalTrials.gov NCT01558921: https://clinicaltrials.gov/study/NCT01558921
- Lancet Oncology 2020: https://doi.org/10.1016/S1470-2045(20)30555-6

## Connected records

- cancers: [Colorectal cancer](https://onco.cc/cancers/colorectal/), [Early-onset colorectal cancer (under 50)](https://onco.cc/cancers/early-onset-colorectal/), [Rectal cancer](https://onco.cc/cancers/rectal-cancer/)
- technologies: [Hypofractionated radiotherapy](https://onco.cc/technologies/hypofractionated-radiotherapy/), [IMRT / IGRT (modern external beam)](https://onco.cc/technologies/imrt-igrt/)
- drugs: [Capecitabine](https://onco.cc/drugs/capecitabine/), [Oxaliplatin](https://onco.cc/drugs/oxaliplatin/)
- trials: [CAO/ARO/AIO-94 (German Rectal Cancer Study)](https://onco.cc/trials/cao-aro-aio-94/), [Dutch TME trial](https://onco.cc/trials/dutch-tme-trial/), [International Watch & Wait Database](https://onco.cc/trials/iwwd/), [STELLAR (rectal cancer)](https://onco.cc/trials/stellar-rectal/), [Stockholm III](https://onco.cc/trials/stockholm-iii/)
- key papers: [Short-course radiotherapy followed by chemotherapy before total mesorectal excision versus preoperative chemoradiotherapy in locally advanced rectal cancer (RAPIDO)](https://onco.cc/key-papers/paper-bahadoer-rapido-short-course-radiotherapy-lancet-oncol-2021/)
- roadmaps: [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](https://onco.cc/roadmaps/colorectal-roadmap/)
- ideas: [Randomise organ preservation against surgery in mismatch repair-proficient rectal cancer, with bowel function as a co-primary endpoint](https://onco.cc/ideas/idea-crc-organ-preservation-randomised-in-pmmr-rectal/)

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