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OPRA showed that about half of people with rectal cancer who receive all their chemotherapy and radiotherapy before surgery can keep their rectum without any drop in the chance of cure, and that giving the chemotherapy after the radiotherapy preserves more rectums.
OPRA randomised 324 patients with MRI-staged stage II or III rectal cancer to induction FOLFOX or CAPOX followed by chemoradiation, or to chemoradiation followed by consolidation FOLFOX or CAPOX. Patients with a clinical complete or near-complete response were offered watch and wait rather than total mesorectal excision.
Three-year disease-free survival was 76 percent in both arms, no different from the historical rate with chemoradiation and surgery. Three-year survival without total mesorectal excision was 41 percent with induction chemotherapy and 53 percent with consolidation chemotherapy; regrowth after watch and wait was salvaged by surgery in almost every case without loss of disease control.
OPRA made organ preservation a planned outcome of rectal cancer treatment rather than a chance finding, and the consolidation sequence is now the preferred order when the goal is to avoid surgery.
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.
324 enrolled.
| Endpoint | Arm | n | Value | HR (95% CI) | p | Source |
|---|---|---|---|---|---|---|
| Survival without total mesorectal excision at 3 yearsprimary | Induction chemotherapy then chemoradiation | 158 | 41% | - | - | link |
| Chemoradiation then consolidation chemotherapy | 166 | 53% | ||||
| Disease-free survival at 3 years | Induction chemotherapy then chemoradiation | 158 | 76% | - | - | link |
| Chemoradiation then consolidation chemotherapy | 166 | 76% |
This is the paper Europe PMC returns for registry id NCT02008656 with the most citations, so it is the natural first reading for anyone following the OPRA trial. Read the abstract above alongside the trial page and the registry entry; the record was linked automatically and its figures have not been checked by hand.
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.
Shares Total neoadjuvant therapy (TNT, rectal cancer), Total mesorectal excision (TME), 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.
Shares International Watch & Wait Database, STELLAR (rectal cancer), CAO/ARO/AIO-12, Randomise organ preservation against surgery in mismatch repair-proficient rectal cancer, with bowel function as a co-primary endpoint.
Shares Total neoadjuvant therapy (TNT, rectal cancer), Total mesorectal excision (TME), Clinical complete response (cCR), Organ preservation (watch-and-wait, bladder-sparing, larynx preservation).
Shares Clinical complete response (cCR), Organ preservation in patients with rectal adenocarcinoma treated with total neoadjuvant therapy (OPRA), Organ preservation (watch-and-wait, bladder-sparing, larynx preservation), Randomise organ preservation against surgery in mismatch repair-proficient rectal cancer, with bowel function as a co-primary endpoint.
Shares International Watch & Wait Database, CAO/ARO/AIO-12, Total mesorectal excision (TME), Chemoradiation (chemoradiotherapy, CRT).
Shares International Watch & Wait Database, STELLAR (rectal cancer), Randomise organ preservation against surgery in mismatch repair-proficient rectal cancer, with bowel function as a co-primary endpoint, 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.
Shares Clinical complete response (cCR), Organ preservation in patients with rectal adenocarcinoma treated with total neoadjuvant therapy (OPRA), Organ preservation (watch-and-wait, bladder-sparing, larynx preservation), Randomise organ preservation against surgery in mismatch repair-proficient rectal cancer, with bowel function as a co-primary endpoint.
Shares Total neoadjuvant therapy (TNT, rectal cancer), Total mesorectal excision (TME), Chemoradiation (chemoradiotherapy, CRT), 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.